Toyokawa Gouji, Takada Kazuki, Okamoto Tatsuro, Kozuma Yuka, Matsubara Taichi, Haratake Naoki, Takamori Shinkichi, Akamine Takaki, Katsura Masakazu, Shoji Fumihiro, Oda Yoshinao, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Clin Lung Cancer. 2017 Sep;18(5):504-511.e1. doi: 10.1016/j.cllc.2016.11.011. Epub 2016 Dec 9.
Emphysematous bullae (EB) are known to be associated with a high incidence of lung cancer; however, the reason for this has yet to be elucidated. The objective of the present study was to clarify the prevalence of programmed death-ligand-1 (PD-L1) expression in EB-associated lung adenocarcinomas.
A total of 369 patients with resected lung adenocarcinoma whose preoperative computed tomography findings were available for the examination of EB were analyzed for PD-L1 expression by immunohistochemistry and evaluated to determine the association between PD-L1 expression and EB-related adenocarcinomas.
Among 369 patients, EB and cancer adjoining EB (Ca-ADJ) were identified in 81 (22.0%) and 50 (13.6%) patients, respectively. EB and Ca-ADJ were significantly associated with male gender, a smoking habit, a decreased forced expiratory volume in 1 second, a relatively higher tumor grade, advanced T status and stage, the presence of pleural and vessel invasion, invasive pathologic subtypes, and wild-type epidermal growth factor receptor. Seventy patients (19.0%) were positive for PD-L1 expression, whereas the remaining 299 patients (81.0%) were negative. Thirty-six (44.4%) and 29 (58.0%) of 81 and 50 patients with EB and Ca-ADJ, respectively, were positive for PD-L1 expression, which was shown to be significant by the Fisher exact test (P < .001 and P < .001, respectively). Among the 81 lung adenocarcinomas with EB, Ca-ADJ was significantly associated with PD-L1 expression (P = .021). In a multivariate analysis, the presence of Ca-ADJ was found to be an independent predictor of PD-L1 expression.
EB-associated lung adenocarcinomas express PD-L1 protein more frequently than those without EB.
已知肺大疱（EB）与肺癌的高发病率相关；然而，其原因尚未阐明。本研究的目的是明确程序性死亡配体1（PD-L1）在与EB相关的肺腺癌中的表达情况。
共有369例接受肺腺癌切除术的患者，其术前计算机断层扫描结果可用于EB检查，通过免疫组织化学分析PD-L1表达，并评估PD-L1表达与EB相关腺癌之间的关联。
在369例患者中，分别有81例（22.0%）和50例（13.6%）患者被诊断为EB和癌旁EB（Ca-ADJ）。EB和Ca-ADJ与男性、吸烟习惯、一秒用力呼气量降低、肿瘤分级相对较高、T分期和阶段进展、胸膜和血管侵犯的存在、浸润性病理亚型以及野生型表皮生长因子受体显著相关。70例患者（19.0%）PD-L1表达呈阳性，其余299例患者（81.0%）为阴性。81例EB患者中有36例（44.4%）PD-L1表达呈阳性，50例Ca-ADJ患者中有29例（58.0%）呈阳性，Fisher精确检验显示差异有统计学意义（P分别<0.001和P<0.001）。在81例伴有EB的肺腺癌中，Ca-ADJ与PD-L1表达显著相关（P = 0.021）。多因素分析发现，Ca-ADJ的存在是PD-L1表达的独立预测因素。
与EB相关的肺腺癌比无EB的肺腺癌更频繁地表达PD-L1蛋白。
