胆管癌手术患者程序性死亡配体1的表达与患者中性粒细胞淋巴细胞比例的关系及其临床意义研究

Programmed Death-Ligand 1(PD-L1) Expression Associated with a High Neutrophil/Lymphocyte Ratio in Cholangiocarcinoma

目的近年来胆管癌的发病率有逐渐增高的趋势,且缺乏有效的治疗手段。本研究旨在探讨胆管癌中PDL1的表达及作用。方法选取我院2015年1月至2017年5月间收治的46名接受手术切除肝外胆管癌患者,对其样本进行福尔马林固定石蜡包埋切片,用抗PD-L1抗体免疫组化染色评估PD-L1的表达。采用Fisher精确检验分析PD-L1和临床病理特征之间关联,采用Cox回归模型进行生存分析。结果在46个样本中,PD-L1在32个(70%)肿瘤细胞膜阳性表达。PD-L1表达的平均水平为1.75%(0-34.7)。PD-L1表达与IV期疾病(OR 3.98,P=0.046)和中性粒细胞/淋巴细胞比值(OR 5.36,P=0.018)显著相关。相对PD-L1阴性的肿瘤样本,PD-L1阳性与较差的总生存率有相关性,但未达到显著水平(7.2vs.7.9个月,P=0.32)。结论 PD-L1在胆管癌中广泛表达,但不能预测总生存期。PD-L1阳性与IV期疾病和高中性粒细胞/淋巴细胞比率呈显著相关。

Objective Effective treatments for cholangiocarcinoma(CCA)are still lacking.This study aimed to investigate the expression of PD-L1 and its relation to possible treatments for CCA.Methods 46 cases of patients with cholangiocarcinoma in our hospital from January 2015 to May 2017 were selected as study objects.Formalin-fixed paraffin-embedded tumor samples from the patients were retrieved.PD-L1 expression was evaluated by immunohistochemistry using anti-PD-L1 antibody.The association between PD-L1,clinico-pathological characteristics was analyzed using Fisher’s exact test,and survival analysis was done with the Cox regression model.Results Out of 46 samples,32(70%)had positive PD-L1 expression in tumor cell membranes.The median level of PD-L1 expression was 1.75%(0-34.7).PD-L1 expression was significantly associated with stage IV disease(OR 3.98,P=0.046)and a high neutrophil/lymphocyte ratio(OR 5.36,P=0.018).PD-L1 positivity was associated with worse overall survival compared with those with a PD-L1 negative tumor but did not reach a level of significance(7.2 vs.7.9 months,P=0.32).Conclusion PD-L1 is widely expressed in CCA but was not predictive for overall survival.PD-L1 positivity was significantly associated with stage IV disease and a high neutrophil/lymphocyte ratio.