转移性胃癌铂类化疗前后程序性死亡配体 1 表达模式的不一致性和变化。
Discordancy and changes in the pattern of programmed death ligand 1 expression before and after platinum-based chemotherapy in metastatic gastric cancer.
机构信息
Department of Internal Medicine, Division of Medical Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea.
Department of Gastric Cancer Centre, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
出版信息
Gastric Cancer. 2019 Jan;22(1):147-154. doi: 10.1007/s10120-018-0842-x. Epub 2018 Jun 2.
BACKGROUND
Our goal was to evaluate changes in PD-L1 expression in primary tumours of metastatic gastric cancer before and after chemotherapy.
METHODS
We evaluated the PD-L1 expression of 72 patients with primary gastric cancer, before and after palliative first-line platinum-based chemotherapy, between January 2015 and March 2017. The PD-L1 ratio was defined as pre-chemotherapy PD-L1 expression divided by the post-chemotherapy PD-L1 expression.
RESULTS
In 30 patients with PD-L1 negative pre-chemotherapy, 12 (40%) were positive post-chemotherapy; among the 42 patients with PD-L1 positive pre-chemotherapy, 24 (57.1%) were negative post-chemotherapy. The degree of PD-L1 expression decreased from 58.3% before chemotherapy to 41.7% after chemotherapy (P = 0.046). Among patients with complete response/partial response (CR/PR), the degree of PD-L1 expression decreased (P = 0.002), as well as PD-L1 positivity with statistical significance (P = 0.013) after chemotherapy, but not among patients with stable disease/progressive disease (SD/PD). Higher disease control rates (CR/PR/SD) were observed in patients with an elevated PD-L1 ratio (P = 0.043). Patients with a high PD-L1 ratio (> 1) were found to be associated with a better progression-free survival (HR 0.34, 95% CI 0.17-0.67, P = 0.002).
CONCLUSIONS
PD-L1 expression can change during chemotherapy. Moreover, changes in patterns of PD-L1 expression might be associated with patient prognosis and response to chemotherapy.
背景
我们的目标是评估转移性胃癌患者的原发肿瘤在化疗前后 PD-L1 表达的变化。
方法
我们评估了 2015 年 1 月至 2017 年 3 月期间 72 例接受姑息性一线铂类化疗的原发性胃癌患者化疗前后 PD-L1 表达情况。PD-L1 比值定义为化疗前 PD-L1 表达除以化疗后 PD-L1 表达。
结果
在化疗前 PD-L1 阴性的 30 例患者中，有 12 例（40%）在化疗后呈阳性；在化疗前 PD-L1 阳性的 42 例患者中，有 24 例（57.1%）在化疗后呈阴性。PD-L1 表达程度从化疗前的 58.3%下降到化疗后的 41.7%（P=0.046）。在完全缓解/部分缓解（CR/PR）患者中，PD-L1 表达程度降低（P=0.002），化疗后 PD-L1 阳性也具有统计学意义（P=0.013），但在病情稳定/进展（SD/PD）患者中则不然。在 PD-L1 比值升高（PD-L1 ratio > 1）的患者中观察到更高的疾病控制率（CR/PR/SD）（P=0.043）。PD-L1 比值较高（> 1）的患者无进展生存期（progression-free survival，PFS）更好（HR 0.34，95%CI 0.17-0.67，P=0.002）。
结论
PD-L1 表达可在化疗过程中发生变化。此外，PD-L1 表达模式的变化可能与患者的预后和对化疗的反应相关。
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