无关免疫缺陷状态可能影响蕈样肉芽肿患者的结局和免疫检查点分子表达：一项临床病理病例对照研究。
Unrelated immunodeficiency states may impact outcomes and immune checkpoint molecule expression in patients with mycosis fungoides: A clinicopathologic case-control study.
机构信息
Department of Pathology, Dermatopathology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
出版信息
J Am Acad Dermatol. 2018 Mar;78(3):530-539. doi: 10.1016/j.jaad.2017.09.015. Epub 2017 Nov 10.
BACKGROUND
Immunodeficiency (ID) correlates with worse outcomes and decreased immune checkpoint molecule expression in melanoma. The impact of ID in mycosis fungoides (MF) is unknown.
OBJECTIVE
Our goal was to evaluate the impact of ID in MF.
METHODS
We conducted a case-control study of 17 patients with MF and ID versus age-, stage-, and race-matched controls as a subset of a comparative analysis of 23 patients with MF with ID (prior lymphoma, recent/current pregnancy, HIV, hypogammaglobulinemia, and prior chemotherapy) versus without ID. Programmed cell death 1 (PD1), programmed death ligand 1 (PDL1), forkhead box p3, and interleukin 17 immunohistochemistry was performed on 12 patients with ID and 10 controls.
RESULTS
Patients with ID had more treatment failure (14 of 23 vs 5 of 17 [P = .028]), more treatment failure within 3 years of diagnosis (12 of 23 vs 4 of 17 [P = .050]), more angiocentrism (6 of 12 vs 0 of 10 [P = .005]), larger cells (1.92 ± 0.51 out of 3 vs 1.30 ± 0.48 out of 3 [P = .009]), more cases with at least 10% PD1 positivity (9 of 11 vs 4 of 10 [P = .031]) and at least 10% PDL1 positivity (7 of 12 vs 2 of 10 [P = .042]), and a higher average percentage of PD1 cells (43.27 ± 40.22 vs 11.2 ± 13.62 [P = .028]). No differences in survival, forkhead box p3 expression, interleukin 17 expression, histologic depth, ulceration, granulomatous changes, or syringotropism were seen.
LIMITATIONS
This was a small single-center study with heterogeneous immunodeficiencies.
CONCLUSION
ID correlated with worse outcomes and increased PD1 and PDL1 expression in MF. Patients with MF and ID may be candidates for immune checkpoint inhibitor therapy, pending further investigation.
背景
免疫缺陷（ID）与黑色素瘤患者的预后较差和免疫检查点分子表达降低相关。ID 在蕈样肉芽肿（MF）中的影响尚不清楚。
目的
我们旨在评估 ID 在 MF 中的影响。
方法
我们进行了一项 17 例 ID 合并 MF 患者与年龄、分期和种族匹配的对照者的病例对照研究，作为 23 例 ID 合并 MF 患者（既往淋巴瘤、近期/当前妊娠、HIV、低丙种球蛋白血症和既往化疗）与无 ID 患者的比较分析的一个亚组。对 12 例 ID 患者和 10 例对照者进行程序性细胞死亡 1（PD1）、程序性死亡配体 1（PDL1）、叉头框蛋白 p3 和白细胞介素 17 免疫组化染色。
结果
ID 患者治疗失败的比例更高（23 例中有 14 例 vs 17 例中有 5 例 [P=0.028]），诊断后 3 年内治疗失败的比例更高（23 例中有 12 例 vs 17 例中有 4 例 [P=0.050]），血管中心性更强（12 例中有 6 例 vs 10 例中无 [P=0.005]），细胞较大（3 个中的 1.92±0.51 与 3 个中的 1.30±0.48 [P=0.009]），PD1 阳性率至少为 10%的病例更多（11 例中有 9 例 vs 10 例中有 4 例 [P=0.031]），PDL1 阳性率至少为 10%的病例更多（12 例中有 7 例 vs 10 例中有 2 例 [P=0.042]），PD1 细胞的平均百分比更高（43.27±40.22 与 11.2±13.62 [P=0.028]）。生存、叉头框蛋白 p3 表达、白细胞介素 17 表达、组织学深度、溃疡、肉芽肿改变、或汗管样改变无差异。
局限性
这是一项小型单中心研究，免疫缺陷具有异质性。
结论
ID 与 MF 患者的预后较差和 PD1、PDL1 表达增加相关。ID 合并 MF 的患者可能是免疫检查点抑制剂治疗的候选者，尚待进一步研究。
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