Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment

BACKGROUND Comprehensive genomic analysis has shown that small bowel adenocarcinoma(SBA)has different genomic profiles from gastric and colorectal cancers.Hence,it is essential to establish chemotherapeutic regimens based on SBA characteristics.The expression of programmed cell death-ligand 1(PD-L1)and programmed cell death-ligand 2(PD-L2)in SBA is not fully understood.Anti-PD-L1/PD-1 therapy uses tumor-infiltrating lymphocytes(TILs);therefore,the status of TILs in the tumor microenvironment(TME)may influence their efficacy.The ratio of FoxP3+to CD8+T cells has been reported to be useful in predicting the prognosis of digestive system cancers.AIM To investigate the clinicopathological significance of PD-L1/2 expression according to the status of TILs in SBA tissues.METHODS We performed immunohistochemical analysis for PD-L1,PD-L2,CD8,FoxP3,and DNA mismatch repair(MMR)proteins using formalin-fixed,paraffin-embedded tissues from 50 patients diagnosed with primary SBA.The immunoreactivities of PD-L1 and PD-L2 were determined separately in tumor cells and tumor-infiltrating immune cells throughout the tumor center and invasive margins,and finally evaluated using the combined positive score(CPS).We assessed CD8+and FoxP3+T cells in the intratumoral and tumor-surrounding stroma.Subsequently,we calculated and summed the ratio of FoxP3 to CD8+T cell counts.Immune-related cell densities were graded as low or high.Immunohistochemical results were compared with clinicopathological factors and patient prognosis.The distribution of cancer-specific survival(CSS)was estimated using the Kaplan–Meier method,and the log-rank test was used to test for significant differences in CSS.A Cox proportional hazard model was also used to assess the effect of tumor variables on CSS.RESULTS PD-L1 expression was positive in 34%in tumor cells(T-PD-L1)and 54%in tumor-infiltrating immune cells(I-PDL1)of the cases examined.T-PD-L2 was positive in 34%and I-PD-L2 was positive in 42%of the cases.PD-L1 CPS≥10 and PD-L2 CPS≥10 were observed in 50%and 56%of the cases,respectively.Deficient MMR(dMMR)was 14%of the cases.T-PD-L1,I-PD-L1 and PD-L1 CPS≥10 were all significantly associated with dMMR(P=0.037,P=0.009,and P=0.005,respectively).T-PD-L1,I-PD-L1,and PD-L1 CPS≥10 were all associated with deeper depth of invasion(P=0.001,P=0.024,and P=0.002,respectively).I-PD-L2 expression and PD-L2 CPS≥10 were significantly higher in the differentiated histological type(P=0.015 and P=0.030,respectively).The I-PD-L1 and IPD-L2 levels were significantly associated with better CSS(P=0.037 and P=0.015,respectively).CD8-high was significantly associated with less lymph node metastasis(P=0.047),less distant metastasis(P=0.024),less peritoneal dissemination(P=0.034),and earlier TNM stage(P=0.047).The CD8-high group had better prognosis than the CD8-low group(P=0.018).FoxP3 expression was not associated with any clinicopathological factors or prognosis.We found that patients with PD-L2 CPS≥10 tended to have worse prognosis in the FoxP3/CD8-low group(P=0.088).CONCLUSION The clinicopathological significance of PD-L1/2 expression may differ depending on the TME status.Immune checkpoint inhibitors may improve the prognosis of SBA patients with low FoxP3/CD8 ratio and PD-L2 expression.

Over-expression of programmed death-ligand 1 and programmed death-1 on antigen-presenting cells as a predictor of organ dysfunction and mortality during early sepsis: a prospective cohort study

BACKGROUND:This study aimed to explore the changes of programmed death-ligand 1(PDL1)and programmed death-1(PD-1)expression on antigen-presenting cells(APCs)and evaluate their association with organ failure and mortality during early sepsis.METHODS:In total,40 healthy controls and 198 patients with sepsis were included in this study.Peripheral blood was collected within the first 24 h after the diagnosis of sepsis.The expression of PDL1 and PD-1 was determined on APCs,such as B cells,monocytes,and dendritic cells(DCs),by flow cytometry.Cytokines in plasma,such as interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),IL-6,IL-10,and IL-17A were determined by Luminex assay.RESULTS:PD-1 expression decreased significantly on B cells,monocytes,myeloid DCs(mDCs),and plasmacytoid DCs(pDCs)as the severity of sepsis increased.PD-1 expression was also markedly decreased in non-survivors compared with survivors.In contrast,PD-L1 expression was markedly higher on mDCs,pDCs,and monocytes in patients with sepsis than in healthy controls and in non-survivors than in survivors.The PD-L1 expression on APCs(monocytes and DCs)was weakly related to organ dysfunction and infl ammation.The area under the receiver operating characteristic curve(AUC)of the PD-1 percentage of monocytes(monocyte PD-1%)+APACHE II model(0.823)and monocyte PD-1%+SOFA model(0.816)had higher prognostic value than other parameters alone.Monocyte PD-1%was an independent risk factor for 28-day mortality.CONCLUSION:The severity of sepsis was correlated with PD-L1 or PD-1 over-expression on APCs.PD-L1 in monocytes and DCs was weakly correlated with infl ammation and organ dysfunction during early sepsis.The combination of SOFA or APACHE II scores with monocyte PD-1%could improve the prediction ability for mortality.

Expression and clinical value of programmed cell death-ligand 1(PD-L1)in diffuse large B cell lymphoma:a retrospective study

Background: The programmed cell death-1(PD-1)/programmed cell death-ligand 1(PD-L1) pathway inhibits the activation of T cells and plays a crucial role in the negative regulation of cellular and humoral immune responses.Diffuse large B-cell lymphoma(DLBCL) is the most common lymphoid malignancy in adults. In the present study, we aimed to detect the expression of PD-L1 in DLBCL and to analyze its relationship with prognosis.Methods: We reviewed medical records of 204 newly diagnosed DLBCL patients in Sun Yat-sen University Cancer Center between October 2005 and August 2012. The expression of PD-L1 in tumor tissues from these 204 patients was detected using immunohistochemical(IHC) assay. The expression of anaplastic lymphoma kinase(ALK), CD5,CD30, and C-Myc in tumor specimens from 109 patients was detected using IHC, and Epstein-Barr virus(EBV)-encoded RNAs(EBERs) were detected using fluorescence in situ hybridization. The Spearman method was used for correlation analysis. The Kaplan-Meier method with log-rank test was used for univariate analysis. Cox proportional hazards model was used for multivariate analysis.Results: Of the 204 patients, 100(49.0%) were PD-L1-positive in tumor cells and 44(21.6%) were PD-L1-positive in tumor microenvironment. PD-L1 expression in tumor cells and tumor microenvironment were more common in the non-germinal center B-cell-like(GCB) subtype than in the GCB subtype(P = 0.02 and P= 0.04). Patients with PD-L1 expression in tumor microenvironment were more likely to be resistant to first-line chemotherapy when compared with the patients without PD-L1 expression in tumor microenvironment(P = 0.03). PD-L1 expression in tumor microenvironment was negatively correlated with C-Myc expression(r =-0.20, P = 0.04). No correlations were detected between PD-L1 expression and the expression of ALK, CD5, and CD30 as well as EBERs. The 5-year overall survival(OS)rates were 50.0% and 67.3% in patients with and without PD-L1 expression in tumor cells(P = 0.02). PD-L1 expression in tumor cells was an independent risk predictor for OS(P < 0.01).Conclusions: PD-L1 expression is more common in the non-GCB subtype than in the GCB subtype. PD-L1 expression in tumor microenvironment has a negative correlation with C-Myc. PD-L1 positivity predicts short survival in DLBCL patients. For patients with PD-L1 expression, more strategy such as anti-PD-L1 antibody treatment should be recommended.

Prognostic value of programmed death.1, programmed death-ligand 1, programmed death-ligand 2 expression, and CD8(+) T cell density in primary tumors and metastatic lymph nodes from patients with stage T1.4N+M0 gastric adenocarcinoma

Background: Anti-programmed death-1/programmed death-ligand 1(PD-1/PD-L1) immunotherapy has been proved to be effective on gastric cancer in ongoing clinical trials. However, the value of PD-L1 in predicting responses of patients with gastric cancer to anti-PD-1/PD-L1 immunotherapy is controversial. Some studies suggested that intra-and inter-tumoral heterogeneity of PD-L1 expression might explain the controversy.This study aimed to analyze the expression of PD-L1, PD-L2, and PD-1 as well as CD8(+) T-cell density in primary tumors and lymph nodes from patients with stage T1-4 N+M0 gastric adenocarcinoma to explore the heterogeneity of PD-1 signaling pathway molecules.Methods: In primary tumors and metastatic as well as non-metastatic lymph nodes from patients with stage T1-4 N+M0 gastric adenocarcinoma, we detected PD-L1 and PD-L2 expression with immunohistochemistry. CD8(+)T-cell density in primary tumors and PD-1 expression on CD8(+)T cells were detected with immunofluorescence. Univariate analysis was used to determine the prognostic values of them. Cox proportional hazard regression model was used to identify independent risk factors that affect patients' overall survival and disease-free survival.Results: Among 119 eligible patients who had undergone surgical resection, the positive rate of PD-L1 was higher in metastatic lymph nodes than in primary tumors(45.4% vs. 38.7%, P = 0.005); the positive rate of PD-1 on CD8(+)T cells was significantly higher in primary tumors and metastatic lymph nodes than in tumor-free lymph nodes(both P < 0.001). The intensity of PD-1 expression on CD8(+) T cells in primary tumors and in metastatic lymph nodes were stronger than that in tumor-free lymph nodes from the same patient. Beside, the positive rate of PD-L2 did not show any differences between primary tumors and metastatic lymph nodes. In multivariate analysis, PD-L1 expression,PD-L2 expression, a low density of CD8(+) T cells in primary tumors, and PD-1 expression on CD8(+) T cells in primary tumors were associated with poor prognosis.Conclusion: The expression of PD-L1 is heterogeneous in primary tumors and in metastatic lymph nodes from patients with stageT1-4 N+M0 gastric adenocarcinoma, which might explain the inconsistent results in assessing the prognostic value of PD-L1 expression in previous studies.

Anti program death-1/anti program death-ligand 1 in digestive cancers

Human tumors tend to activate the immune system regulatory checkpoints as a means of escaping immunosurveillance. For instance, interaction between program death-1(PD-1) and program death-ligand 1(PD-L1) will lead the activated T cell to a state of anergy. PD-L1 is upregulated on a wide range of cancer cells. Anti-PD-1 and anti-PD-L1 monoclonal antibodies(m Abs), called immune checkpoint inhibitors(ICIs), have consequently been designed to restore T cell activity. Accumulating data are in favor of an association between PD-L1 expression in tumors and response to treatment. A PD-L1 expression is present in 30% to 50% of digestive cancers. Multiple anti-PD-1(nivolumab, pembrolizumab) and anti-PD-L1 m Abs(MPDL3280A, Medi4736) are under evaluation in digestive cancers. Preliminary results in metastatic gastric cancer with pembrolizumab are highly promising and phase Ⅱ will start soon. In metastatic colorectal cancer(CRC), a phase Ⅲ trial of MPDL3280 A as maintenance therapy will shortly be initiated. Trials are also ongoing in metastatic CRC with high immune T cell infiltration(i.e., microsatellite instability). Major challenges are ahead in order to determine how, when and for which patients we should use these ICIs. New radiologic criteria to evaluate tumor response to ICIs are awaiting prospective validation. The optimal therapeutic sequence and association with cytotoxic chemotherapy needs to be established. Finally, biomarker identification will be crucial to selection ofpatients likely to benefit from ICIs.

Relationship Between Programmed Death-ligand 1 and Clinicopathological Characteristics in Non-small Cell Lung Cancer Patients

Objective To evaluate the correlation between programmed death-ligand 1(PD-L1)expression in primary lung cancer cells,tumor associated macrophages(TAM)and patients’clinicopathological characteristics.Methods From 2008 to 2010,208 non-small cell lung cancer patients who underwent surgery or CT-guided biopsy were recruited from Huadong Hospital,Fudan University.Immunohistochemistry staining was performed to evaluate the PD-L1 expression in both primary lung cancer cells and CD68 positive TAM.The relationship between PD-L1 expression and the clinical pathology was evaluated usingχ2test.Spearman’s rank correlations were used to determine the correlation between PD-L1 expression in tumor cells and macrophages.Results Positive PD-L1 expression in primary cancer cells was found in 136(65.3%)patients,which were negatively correlated with lymph node metastasis(P=0.009)and smoking history(P=0.036).Besides,TAM with PD-L1 expression(found in 116 patients)was positively associated with smoking history(P=0.034),well-differentiation(P=0.029)and negative lymph node metastasis(P=0.0096).A correlation between PD-L1 expression in primary tumor cells and non-small cell lung cancer associated macrophages was found(r=0.228,P=0.021).Conclusion PD-L1,secreted from TAM,might induce cancer cells apoptosis,and decrease lymph node metastasis.

ITP患者PD-1/PD-L1表达特点及其在Treg与Breg细胞之间的相互作用机制分析

目的探讨原发免疫性血小板减少症(ITP)患者细胞程序性死亡受体-1(PD-1)/细胞程序性死亡配体1(PD-L1)表达特点及其在调节性T细胞(Treg)、调节性B细胞(Breg)间的相互作用。方法选取2018年12月—2022年1月在我院治疗的ITP患者106例作为观察组,其中轻度患者32例,中度患者44例,重度患者30例。同时选取同期健康志愿者100例作为对照组。检测两组Treg细胞百分比、Breg细胞百分比、Treg细胞表面PD-1阳性率、Breg细胞表面PD-L1阳性率等,同时分析观察组不同病情程度患者各指标差异。结果观察组Breg细胞百分比、Treg细胞百分比、TGF-β、IL-10和IL-4水平均明显低于对照组(P<0.05);观察组Treg细胞表面PD-1阳性率、Breg细胞表面PD-L1阳性率、可溶性程序性细胞死亡蛋白-1(sPD-1)和IL-17水平均明显高于对照组(均P<0.05);两组可溶性程序性细胞死亡蛋白配体-1(sPD-L1)水平比较差异无统计学意义(P>0.05)。观察组重度患者Breg细胞百分比、Treg细胞百分比均明显低于轻度和中度患者(均P<0.05),而Treg细胞表面PD-1阳性率、Breg细胞表面PD-L1阳性率均明显高于轻度和中度患者(均P<0.05)。Treg细胞表面PD-1阳性率与Breg细胞表面PD-L1阳性率呈正相关(r=0.446,P<0.05)。观察组治疗后Breg细胞百分比、Treg细胞百分比、TGF-β、IL-10和IL-4水平有所升高(P<0.05),而Treg细胞表面PD-1阳性率、Breg细胞表面PD-L1阳性率、sPD-1和IL-17水平有所降低(P<0.05),治疗前后sPD-L1水平比较差异无统计学意义(P>0.05)。结论ITP患者Treg细胞表面PD-1和Breg细胞表面PD-L1阳性率明显升高,与患者病情严重程度呈正相关,同时Treg细胞表面PD-1和Breg细胞表面PD-L1表达之间存在相关性。

铜绿假单胞菌脓毒症患者程序性细胞死亡受体1/程序性细胞死亡配体1信号通路相关蛋白与短期临床预后的相关性分析

目的探讨程序性细胞死亡受体1/程序性细胞死亡配体1(PD-1/PD-L1)信号通路相关蛋白对铜绿假单胞菌(PA)脓毒症患者短期临床预后的影响。方法选择2021年1月—2023年6月宁夏医科大学总医院收治的122例PA脓毒症患者为研究对象,均根据脓毒症治疗指南和实际病情开展治疗。收集患者临床资料、治疗前慢性健康状况评分系统Ⅱ(APACHEⅡ)评分;治疗前抽取外周静脉血测定T淋巴细胞水平(CD3^(+)、CD4^(+)、CD8^(+))以及血清PD-1和PD-L1水平。结果122例PA脓毒症患者入住急诊重症监护室及其他科室后28 d存活101例(82.79%,存活组),死亡21例(17.21%,死亡组)。存活组与死亡组患者高血压比率、慢性阻塞性肺病比率、慢性肝病比率、APACHEⅡ评分、CD4^(+)、CD4^(+)/CD8^(+)、PD-1和PDL-1比较,差异有统计学意义(P<0.05)。单因素Logistic回归分析结果显示,基础疾病(高血压、慢性阻塞性肺病、慢性肝病)、APACHEⅡ评分、CD4^(+)/CD8^(+)、PD-1和PD-L1均是PA脓毒症患者短期生存的影响因素(P<0.01)。多因素Logistic回归分析结果显示,基础疾病(高血压、慢性阻塞性肺病、慢性肝病)、APACHEⅡ评分、PD-1和PD-L1均是PA脓毒症患者短期生存的影响因素(P<0.01)。结论PD-1/PD-L1信号通路对PA脓毒症患者的临床预后有影响,该通路相关蛋白表达上调可增加PA脓毒症患者短期临床预后不良的风险。

西藏地区结直肠癌免疫治疗和靶向治疗相关分子标志物的检测及意义

目的研究西藏地区结直肠癌中SWI/SNF相关、基质相关、肌动蛋白依赖性染色质调节因子A亚科成员4(SMARCA4)/Brahma相关基因1、V-raf鼠类肉瘤病毒癌基因同源物B(BRAF)、P53、程序性死亡受体1(PD-1)及程序性死亡配体1(PD-L1)免疫组织化学表达和BRAF、神经营养因子酪氨酸受体激酶(NTRK)基因改变情况,为西藏地区结直肠癌患者的靶向治疗及免疫治疗提供依据。方法收集2015年1月至2021年7月西藏自治区人民医院经手术切除病理确诊为结直肠癌病例64例,全部病例均进行SMARCA4、BRAF、P53、PD-1、PD-L1免疫组织化学染色和NTRK1、NTRK2、NTRK3融合基因荧光原位杂交检测及BRAF V600E基因突变PCR检测。结果64例结直肠癌病例男女比例1.21∶1,平均年龄(56.59±13.27)岁;46例(71.88%)位于结肠,18例(28.12%)位于直肠;60例(93.75%)为腺癌,4例(6.25%)为其他类型;11例(17.19%)为T1或T2期,53例(82.81%)为T3或T4期;24例(37.50%)出现淋巴结转移。免疫组织化学方面,64例中1例(1.56%)SMARCA4部分肿瘤细胞表达减弱或缺失,4例(6.25%)BRAF肿瘤细胞阳性表达,35例(54.69%)P53为突变型表达;45例(70.31%)PD-1肿瘤相关免疫细胞阳性比例分数<10%,19例(29.69%)≥10%;52例(81.25%)PD-L1联合阳性分数<10,12例(18.75%)≥10。64例NTRK1、NTRK2、NTRK3融合基因检测均为阴性;4例(6.25%)检测到BRAF V600E基因突变;1例SMARCA4表达缺失病例未检测到SMARCA4基因改变。PD-L1的表达与错配修复缺陷/高度微卫星不稳定和PD-1的高表达呈显著正相关(χ^(2)=10.223,P=0.001;χ^(2)=11.979,P=0.001)。结论西藏地区结直肠癌中较少出现SMARCA4表达减弱或缺失及NTRK融合基因改变,少数病例有BRAF V600E基因突变,Pan-TRK和BRAF免疫组织化学可作为NTRK融合基因及BRAF基因突变的初筛方法。错配修复缺陷/高度微卫星不稳定的病例中更容易出现PD-L1蛋白高表达,这部分患者有望获益于免疫治疗。P53突变与PD-L1表达无相关性,PD-1的高表达和PD-L1的高表达呈正相关。

S-烯丙基巯基半胱氨酸促进CD8+T细胞杀伤功能的机制研究

目的探究S-烯丙基巯基半胱氨酸(S-allylmercaptocysteine,SAMC)对CD8^(+)T细胞杀伤鼻咽癌细胞功能的影响及机制。方法将人鼻咽癌细胞HK-1和C666-1与SAMC共培养,分为0、25、50、100μmol/L SAMC组,Western blot检测肿瘤细胞程序性死亡配体-1(programmed cell death-ligand 1,PD-L1)表达。CD8^(+)T细胞分别与HK-1和C666-1细胞以10∶1的比例共培养并加入0、25、50、100μmol/L SAMC,检测CD8^(+)T对HK-1和C666-1的杀伤能力,酶联免疫法(ELISA)检测干扰素(INF-γ)和肿瘤坏死因子-α(TNF-α)浓度,构建鼻咽细胞HK-1的小鼠皮下移植瘤模型,分为对照组、CD8^(+)T细胞组、SAMC组、SAMC+CD8^(+)T细胞组,各组小鼠治疗期间测量瘤体积,治疗结束后取小鼠肿瘤组织,Western blot检测肿瘤组织中PD-L1表达,ELISA检测小鼠血清INF-γ和TNF-α浓度。结果相比于0μmol/L SAMC组,25、50、100μmol/L SAMC组HK-1和C666-1细胞PD-L1表达均显著下调(P<0.05),相比于0μmol/L SAMC+CD8^(+)T细胞组,25、50、100μmol/L SAMC+CD8^(+)T细胞组HK-1和C666-1细胞培养上清中INF-γ和TNF-α浓度均能显著增加,HK-1和C666-1细胞裂解率显著增加(P<0.01)。相比于对照组,CD8^(+)T细胞组和SAMC+CD8^(+)T细胞组小鼠瘤体积和瘤重显著下降(P<0.05),小鼠血清INF-γ和TNF-α浓度显著增加,相比于CD8^(+)T细胞组,SAMC+CD8^(+)T细胞组小鼠瘤体积和瘤重显著下降(P<0.05),小鼠血清INF-γ和TNF-α浓度显著增加(P<0.05),肿瘤组织PD-L1表达显著下调(P<0.01)。结论SAMC可通过抑制人鼻咽癌细胞PD-L1表达而促进CD8^(+)T细胞的杀伤功能。

自然杀伤细胞2组成员A、程序性死亡因子配体1表达检测对PD-L1阻断免疫治疗肌层浸润性膀胱癌反应性的预测价值

目的:探究自然杀伤细胞2组成员A(NKG2A)及程序性死亡因子配体1(PD-L1)表达检测对PD-L1阻断免疫治疗肌层浸润性膀胱癌反应性的预测价值。方法:选取100例肌层浸润性膀胱癌患者作为研究对象,对其行PD-L1阻断免疫治疗后,根据治疗反应性将其分为缓解组和未缓解组;对缓解组患者随访3个月,将其分为复发组和未复发组。比较两组患者NKG2A和PD-L1在CD4^(+)和CD8^(+)上的表达水平,采用ROC曲线分析NKG2A和PD-L1预测膀胱癌患者治疗反应性的价值。结果:100例研究对象中,缓解组患者72例(72.00%),未缓解组患者28例(28.00%),两组性别、年龄比较无统计学差异(均P>0.05),但缓解组患者肿瘤直径小于未缓解组,NKG2A、PD-L1/CD4^(+)和PD-L1/CD8^(+)表达水平均低于未缓解组(均P<0.05)。膀胱癌患者NKG2A、PD-L1/CD4^(+)和PD-L1/CD8^(+)表达预测免疫治疗后缓解的AUC值分别为0.771、0.724、0.710;联合诊断的AUC为0.836。72例缓解患者中,出现复发29例(40.28%),未出现复发43例(59.72%),两组性别、年龄以及肿瘤直径比较无统计学差异(均P>0.05),但复发组NKG2A、PD-L1/CD4^(+)和PD-L1/CD8^(+)表达水平均高于未复发组(均P<0.05)。NKG2A、PD-L1/CD4^(+)和PD-L1/CD8^(+)表达预测膀胱癌患者缓解后复发的AUC值分别为0.775、0.740、0.728;联合诊断的AUC为0.874。结论:NKG2A、PD-L1/CD4^(+)和PD-L1/CD8^(+)在不同治疗反应性肌层浸润性膀胱癌患者外周血中表达水平不同,三者对于膀胱癌患者PD-L1阻断免疫治疗反应性均有一定的预测价值,且三者联合预测效能最佳。

血清OPN、sPD-L1、miR-370在急性髓系白血病中的表达及与危险分层的关系

目的:分析血清骨桥蛋白(OPN)、可溶性程序性死亡因子配体-1(sPD-L1)、微小RNA-370(miR-370)在急性髓系白血病(AML)中的表达及与危险分层的关系。方法:选取2021年11月—2023年2月本院诊治的79例AML患者作为研究对象,根据相关标准分为低危组(n=26)、中危组(n=39)及高危组(n=14)。比较3组治疗前后血清OPN、sPD-L1、miR-370、白细胞计数(WBC)、血红蛋白(Hb)水平,采用Pearson分析血清OPN、sPD-L1、miR-370水平与WBC、Hb水平相关性,采用受试者工作特征曲线(ROC)分析治疗前血清OPN、sPD-L1、miR-370水平联合检测对AML患者危险分层情况的诊断价值。结果:3组治疗前后血清OPN、sPD-L1、miR-370、WBC水平比较:低危组<中危组<高危组(P<0.05);血清Hb水平比较:低危组>中危组>高危组(P<0.05);治疗前后血清OPN、sPD-L1、miR-370水平与WBC水平呈正相关(治疗前:r=0.637、0.629、0.661,治疗后:r=0.432、0.422、0.544,P<0.05),与Hb水平呈负相关(治疗前:r=-0.655、-0.648、-0.646,治疗后:r=-0.519、-0.507、-0.438,P<0.05);治疗前血清OPN、sPD-L1、miR-370联合检测诊断AUC为0.942,高于单一检测(P<0.05)。结论:血清OPN、sPD-L1、miR-370水平与AML患者病情程度、分层情况密切相关,可为临床诊疗提供参考。

Immune signature of small bowel adenocarcinoma and the role of tumor microenvironment

In this editorial we comment on the article published“Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment”.Small bowel adenocarcinoma(SBA)is a rare gastrointestinal neoplasm and despite the small intestine's significant surface area,SBA accounts for less than 3%of such tumors.Early detection is challenging and the reason arises from its asymptomatic nature,often leading to late-stage discovery and poor prognosis.Treatment involves platinum-based chemotherapy with a 5-fluorouracil combination,but the lack of effective chemotherapy contributes to a generally poor prognosis.SBAs are linked to genetic disorders and risk factors,including chronic inflammatory conditions.The unique characteristics of the small bowel,such as rapid cell renewal and an active immune system,contributes to the rarity of these tumors as well as the high intratumoral infiltration of immune cells is associated with a favorable prognosis.Programmed cell death-ligand 1(PD-L1)expression varies across different cancers,with potential discrepancies in its prognostic value.Microsatellite instability(MSI)in SBA is associated with a high tumor mutational burden,affecting the prognosis and response to immunotherapy.The presence of PD-L1 and programmed cell death 1,along with tumor-infiltrating lymphocytes,plays a crucial role in the complex microenvironment of SBA and contributes to a more favorable prognosis,especially in the context of high MSI tumors.Stromal tumor-infiltrating lymphocytes are identified as independent prognostic indicators and the association between MSI status and a favorable prognosis,emphasizes the importance of evaluating the immune status of tumors for treatment decisions.

Comparison of mismatch repair and immune checkpoint protein profile with histopathological parameters in pancreatic,periampullary/ampullary,and choledochal adenocarcinomas

BACKGROUND Pancreatic,periampullary/ampullary,and choledochal adenocarcinomas are aggressive malignancies with a poor prognosis.Immune checkpoint blockade is a promising treatment option for several tumor types.H long terminal repeatassociating 2(HHLA2),which is analogous to programmed death-ligand 1(PDL1),is a recently discovered member of the B7/cluster of differentiation 28 family and is expressed in many malignancies.AIM To analyze the expression of HHLA2 and its association with the pathologic biomarkers that predict sensitivity to immunotherapy.METHODS Ninety-two adenocarcinoma cases located in the pancreas,ampulla,and distal common bile duct were identified.This study assessed 106 pancreaticoduodenectomy and distal/total pancreatectomy samples that were delivered to Ankara City Hospital between 2019 and 2021.Immunohistochemistry was conducted to examine the expression of DNA mismatch repair(MMR),PD-L1,and HHLA2 proteins.RESULTS Patients with high HHLA2 expression had a higher mean age than those with low expression.Low HHLA2 expression was associated with high perineural invasion.HHLA2 expression was low in pathological stage T3(pT)3 cases and high in pathological stage T1,T2,and T4 cases.There was no correlation between HHLA2 expression and the expression of MMR proteins and PD-L1.CONCLUSION Evaluation of HHLA2 expression in microsatellite stable and PD-L1-negative tumors may be useful for predicting the response of individuals to immunotherapy and may serve as a novel therapeutic target for immunotherapy in advanced-stage disease.

循环肿瘤细胞PD-L1表达对鼻咽癌患者的预后价值评估

目的探讨循环肿瘤细胞(CTC)上细胞程序性死亡配体1(PD-L1)表达对鼻咽癌患者预后的意义。方法收集2021年6月10日—2023年7月10日经病理学确诊的鼻咽癌患者59例,检测患者外周血CTC和PD-L1的表达情况。分析CTC和PD-L1+CTC与鼻咽癌患者临床病理特征的相关性;评估CTC和PD-L1+CTC检测对鼻咽癌患者预后的临床诊断价值。结果59例患者的CTC检出率为76.3%(45/59),检出数量为(1.4±1.1)个。不同M分期,CTC检出数量的差别有统计学意义(P=0.026)。PD-L1+CTC的检出率为35.6%(21/59),检出数量为(0.4±0.7)个。鼻咽癌患者的2 a疾病进展率为8.5%(5/59),PD-L1+CTC患者相较于PD-L1-CTC患者具有更低的无进展生存率(PFS)和总生存率(OS),差别均有统计学意义(P=0.016,P=0.012)。Cox回归分析显示,PD-L1+CTC是鼻咽癌患者PFS(HR=9.244,95%CI:1.030~82.991,P=0.047)和OS(HR=190.642,95%CI:1.389~341.562,P=0.023)的预后影响因素。结论PD-L1+CTC是鼻咽癌患者PFS和OS的预后影响因素,CTC和PD-L1检测可能辅助鼻咽癌患者的预后评估。

基于CT影像组学列线图预测实性非小细胞肺癌组织PD-L1蛋白表达状态

目的:基于CT影像组学预测实性非小细胞肺癌(non-small cell lung cancer,NSCLC)组织细胞程序性死亡-配体1(programmed death ligand 1,PD-L1)蛋白表达状态的价值。方法:回顾性分析经病理证实为NSCLC且影像学上肿瘤表现为实性的患者116例,其中鳞癌55例,腺癌61例,分析其临床与影像资料,筛选临床独立预测因子并构建临床模型。将图像导出并对其平扫及动脉期图像进行配准,手动逐层勾画肿瘤的感兴趣区域并提取影像组学特征,经过特征筛选后构建影像组学模型并计算每例患者影像组学评分,将影像组学评分与临床独立预测因子进行联合构建列线图。使用受试者工作特征曲线(receiver operating characteristic curve,ROC)的曲线下面积(area under the curve,AUC)评估模型诊断效能,使用决策分析曲线(decision curve analysis,DCA)评价模型的临床效用,利用DeLong检验评估模型之间差异。此外,按鳞癌和腺癌两种病理分型进行分组并进行亚组分析。结果:空洞和影像组学评分是预测PD-L1表达的临床独立预测因子(空洞有优势比为3.624,影像组学优势比为2.532)。列线图的诊断表现(训练组AUC vs验证组AUC:0.861 vs 0.803)优于影像组学模型(AUC:0.847 vs 0.777)和临床模型(AUC:0.608 vs 0.570)。决策曲线表明,列线图相比与临床模型和影像组学模型具有更高的临床应用价值。亚组分析中,列线图仍然具有很好的诊断效能,且在鳞癌组中的诊断效能优于腺癌组。结论:CT影像组学列线图能够在术前有效的预测实性NSCLC组织PD-L1蛋白表达状态,能够为临床方案选择和术前决策提供帮助。

非小细胞肺癌患者抗PD-1/PD-L1治疗疗效及其肠道菌群特征分析

目的分析非小细胞肺癌(NSCLC)患者抗程序性死亡受体1(PD-1)/程序性死亡配体1(PD-L1)治疗疗效及其肠道菌群特征。方法将2020年1月至2022年1月新疆维吾尔自治区人民医院收治的81例NSCLC患者作为研究对象,根据患者免疫治疗应答情况,将患者分为无应答组及应答组,比较两组患者临床资料及肠道菌群分布差异,并采用Spearman相关性分析患者无进展生存期(PFS)与肠道菌群α多样性指标之间的相关性。结果应答组吸烟患者比例显著低于无应答组,差异有统计学意义(χ^(2)=4.648,P=0.031)。无应答组Chao1指数、ACE指数及香农-威纳指数患者低于应答组,辛普森多样性指数高于应答组,差异有统计学意义(P<0.05)。Chao1指数、ACE指数及香农-威纳指数与PFS呈正相关(r=0.526、0.579、0.539,均P<0.05),而辛普森多样性指数与PFS呈负相关(r=-0.867,P<0.001)。采用主坐标分析对肠道菌群β多样性结构进行分析,第一主成分贡献率为70.36%,第二主成分贡献率为16.63%。结论NSCLC患者肠道菌群多样性及分布与抗PD-1/PD-L1治疗有关,患者肠道菌群多样性越高,抗PD-1/PD-L1治疗越敏感。

程序性死亡受体/配体免疫治疗策略在人乳头瘤病毒阳性头颈部鳞状细胞癌中的研究进展

人乳头瘤病毒(HPV)感染已成为头颈部鳞状细胞癌(HNSCC)的主要致病因素之一,与HPV阴性相比,HPV阳性HNSCC表现出以程序性死亡受体(PD)为代表的多种免疫细胞及其效应分子的表达增加。PD-1/PD-L1高表达的患者与HPV阳性HNSCC患者存活率的显著提高相关。而HPV阳性HNSCC患者在接受抗PD-1/程序性死亡配体(PD-L1)免疫治疗后的客观缓解率、无进展生存期、总生存期等指标较HPV阴性HNSCC患者有所提高,提示HPV阳性HNSCC患者在接受抗PD-1/PD-L1免疫治疗上可能取得更好疗效。另外,PD-1/PD-L1抑制剂联合HPV癌症疫苗、双通路抑制剂等免疫治疗方案在HPV相关癌症中已发挥出独特的优势。根据HPV状态为患者制定个体化免疫治疗是一种有前景的治疗策略。

神经介素B及受体NMBR和PD-L1在H9N2亚型流感病毒感染过程中的相互作用研究

神经介素B(NMB)及其G蛋白偶联受体(NMBR)发挥的抗甲型流感病毒免疫反应,以及甲型流感病毒感染诱导细胞程序性死亡配体1(PD-L1)高表达均与NF-κB信号通路有直接关系,而NF-κB信号通路的激活受ERK信号通路的调控。为深入探究NMB与NMBR调节H9N2亚型流感病毒感染诱导PD-L1上的作用,本研究以H9N2亚型流感病毒为模式毒株,基于NMBR干扰和过表达细胞系、PD-L1干扰和过表达细胞系以及C57BL/6小鼠,采用RT-PCR和Western blot方法分析NMB与NMBR对PD-L1表达变化以及ERK磷酸化的影响。结果显示:H9N2亚型流感病毒感染诱导的NMBR和PD-L1表达之间存在着负调控的关系,外源性NMB可以有效激活小鼠体内NMBR的表达,进而抑制PD-L1表达,NMB与NMBR也能影响H9N2感染诱导的ERK磷酸化水平。综上,H9N2亚型流感病毒感染诱导表达的NMB与NMBR通过ERK信号通路调节PD-L1的表达而发挥抗流感病毒作用,将为深度剖析宿主-甲型流感病毒之间的互作关系提供新的科学依据。

轻中度与重度PD-1/PD-L1免疫检查点抑制剂相关性肺炎的临床和CT特征比较

目的探讨轻中度与重度程序性死亡受体1(PD-1)/程序性死亡配体1(PD-L1)免疫检查点抑制剂(ICI)相关性肺炎的临床和CT特征的差异。方法选取2018年9月至2021年9月在浙江省肿瘤医院接受PD-1/PD-L1 ICI治疗且发生ICI相关性肺炎的21例患者为研究对象,依据美国卫生和公共服务部发布的不良事件评定标准5.0版将ICI相关性肺炎患者分为轻中度14例和重度7例,比较两组患者临床特征(主要包括ICI治疗至肺炎发生时间、原发灶病理类型、放疗史、免疫治疗方式、临床症状等)和CT特征(主要包括CT分型、病灶密度、病灶位置、有无胸腔积液等)。结果临床特征比较发现,轻中度组女性、无症状患者占比以及BMI均明显高于重度组(均P<0.05);两组患者在年龄、ICI治疗至肺炎发生时间、吸烟史、原发灶分类、原发灶病理类型、放疗史、ICI类型、免疫治疗方式、免疫治疗线数、胸闷气急、咳嗽咳痰、发热、呼吸衰竭等方面比较,差异均无统计学意义(均P>0.05)。轻中度组CT分型为机化性肺炎型、病灶位于肺外周、病灶两肺未对称的占比均明显高于重度组(均P<0.05);两组患者在病灶密度、小叶间隔增厚、病变分布、胸腔积液等方面比较,差异均无统计学意义(均P>0.05)。结论轻中度与重度PD-1/PD-L1 ICI相关性肺炎患者的临床特征和CT特征存在明显差异。