PD-L1在不同亚型三阴性乳腺癌中的表达及与患者预后的相关性分析

The Expression of PD-L1 in Different Molecular Subtypes of Triple-Negative Breast Cancer and Its Correlation with Prognosis

摘要: 目的：探讨分析细胞程序性死亡–配体1 (PD-L1)在不同亚型三阴性乳腺癌组织中的表达及与患者预后的相关性。方法：选择240名接受根治性切除前未行新辅助治疗的三阴性乳腺癌(TNBC)患者进行PD-L1表达的免疫组化结果分析，其中四种亚型的TNBC患者各60例。使用Kaplan-Meier、单变量和多变量Cox比例风险模型分析来比较不同亚型PD-L1表达与患者生存时间的关系。结果：中位随访时间为55.75个月(范围：23.28~120.02个月)。与PD-L1阴性的TNBC患者相比，PD-L1阳性的TNBC患者的总生存期(OS)明显增加(P = 0.029)。在不同分型的TNBC组织中PD-L1表达率最高的是免疫调节型(IM)为26.7%，伴随其较好的预后。而不同的临床分期(TNM分期)、组织学分级、有无淋巴结转移在不同分型的TNBC中PD-L1的阳性表达率存在显著差异性(P < 0.05)，其中IM在四种亚型的TNBC患者中OS明显延长。单因素Cox比例模型分析表明，PD-L1是TNBC的独立预后因素。结论：PD-L1在不同分型的TNBC中对预后的影响不同，其中在IM分型中与预后的关系最密切。

Abstract: Objective: To investigate the expression of PD-L1 in different subtypes of triple-negative breast cancer and its correlation with the prognosis of patients. Methods: A total of 240 patients with tri-ple-negative breast cancer (TNBC) who had not received neoadjuvant therapy before radical resec-tion were selected for immunohistochemical study of PD-L1 expression, including 60 patients with four subtypes of TNBC. Kaplan-Meier and univariate Cox proportional hazard model analysis were used to compare the relationship between PD-L1 expression and survival time of patients with dif-ferent subtypes. Results: The median follow-up time was 55.75 months (range: 23.28~120.02 months). Overall survival (OS) was significantly increased in PD-L1-positive TNBC patients com-pared with PD-L1-negative TNBC patients (P = 0.029). Among the different types of TNBC tissues, the highest expression rate of PD-L1 was 26.7% in immunomodulatory type (IM), which was ac-companied by a better prognosis. There were significant differences in the positive expression rate of PD-L1 among different types of TNBC with different TNM stages, histological grades, and lymph node metastasis (P < 0.05), and OS was significantly prolonged in the four subtypes of TNBC patients with IM. Univariate Cox proportional model analysis showed that PD-L1 was an independent prog-nostic factor for TNBC. Conclusion: PD-L1 has different effects on prognosis in different types of TNBC, and the relationship between PD-L1 and prognosis is most close in IM type.