Jiang Ling, Lin Zhiyi, Li Na, Jiang Jinfang, Lu Cengceng, Du Shenghang, Zhang Jun, Wang Yuanyuan, Chen Jun, Gong Ping
First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832002, China.
Suining Central Hospital, Suining 629000, China.
Zhongguo Fei Ai Za Zhi. 2021 Sep 20;24(9):623-631. doi: 10.3779/j.issn.1009-3419.2021.102.31. Epub 2021 Aug 30.
BACKGROUND: The treatment mode of lung cancer is epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) as a first-line treatment for patients with EGFR mutant in non-small cell lung cancer (NSCLC). At the same time programmed death receptor 1 (PD-1) and its programmed death receptor ligand 1 (PD-L1) inhibitors therapy as the representative immune checkpoint inhibitors (ICIs) has a significant effect in the treatment of lung cancer. The aim of this study was to investigate the correlation between the expression of PD-1 and PD-L1 in NSCLC and clinicopathologic feature, EGFR gene mutation. METHODS: The protein expression of PD-1 and PD-L1 was detected by immunohistochemistry from 127 patients with NSCLC and EGFR gene mutation was detected by quantitative polymerase chain reaction (qPCR) to analyze its relation with clinicopathologic feature. Also, the correlation between protein expression of PD-1 and PD-L1 and EGFR mutation. RESULTS: The PD-1 positive expression in NSCLC tumor cells and tumor infiltrating immune cells is 53.5% (68/127), PD-L1 is 57.5% (73/127). The PD-1 and PD-L1 expression significantly higher in well-differentiated and moderately-differentiated carcinoma than poorly differentiated carcinoma, I+II than III+IV in clinical staging (P<0.05). The EGFR mutation rate was 46.5% (59/127), correlate with female, without smoking history, adenocarcinoma and well-differentiated and moderately-differentiated patients respectively higher than male, smoking history, squamous carcinoma and poorly differentiated patients (P<0.05). The protein expression of PD-L1 and PD-1 had the consistency in NSCLC patients (kappa=0.107,5, P=0.487). There was a negative correlation between the EGFR mutation and PD-1 and PD-L1 expression (Φ=-0.209, Φ=-0.221, P<0.05). Follow-up of NSCLC patients, the median total survival in under the age of 65, adenocarcinoma, well-differentiated and moderately-differentiated, with PD-L1 expression patients respectively higher than over the age of 65, squamous carcinoma, poorly differentiated, without PD-L1 expression patients (P<0.05). The median survival of hypo expression patients of PD-L1 significantly higher than hyper expression patient (P=0.04). CONCLUSIONS: According to the Chinese Expert Consensus on Standards of PD-L1 immunohistochemistry testing for NSCLC, we tested the PD-L1 expression in NSCLC and then the dominant population of anti-PD-1/PD-L1 treatment was screened out. Patients with EGFR mutation were also detected and EGFR mutation was negatively correlated with the expression of PD-1 and PD-L1 as well. On the basis of PD-L1 expression and EGFR mutation status, it may benefit NSCLC patients from individualized treatment. Meanwhile, patients who were under the age of 65, adenocarcinoma, well-differentiated and moderately-differentiated, hypo expression of PD-L1 have a relatively good prognosis, to provide reference for the prognosis evaluation of NSCLC.
背景:肺癌的治疗模式为表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)作为非小细胞肺癌(NSCLC)中EGFR突变患者的一线治疗。同时,以程序性死亡受体1(PD-1)及其程序性死亡受体配体1(PD-L1)抑制剂疗法为代表的免疫检查点抑制剂(ICIs)在肺癌治疗中具有显著疗效。本研究旨在探讨NSCLC中PD-1和PD-L1的表达与临床病理特征、EGFR基因突变之间的相关性。 方法:采用免疫组织化学法检测127例NSCLC患者的PD-1和PD-L1蛋白表达,采用定量聚合酶链反应(qPCR)检测EGFR基因突变,分析其与临床病理特征的关系。同时,分析PD-1和PD-L1蛋白表达与EGFR突变之间的相关性。 结果:NSCLC肿瘤细胞和肿瘤浸润免疫细胞中PD-1阳性表达率为53.5%(68/127),PD-L1为57.5%(73/127)。高分化和中分化癌中PD-1和PD-L1表达明显高于低分化癌,临床分期I+II期高于III+IV期(P<0.05)。EGFR突变率为46.5%(59/127),与女性、无吸烟史、腺癌以及高分化和中分化患者相关,分别高于男性、有吸烟史、鳞癌和低分化患者(P<0.05)。NSCLC患者中PD-L1和PD-1蛋白表达具有一致性(kappa=0.107,5,P=0.487)。EGFR突变与PD-1和PD-L1表达呈负相关(Φ=-0.209,Φ=-0.221,P<0.05)。对NSCLC患者进行随访,65岁以下、腺癌、高分化和中分化、有PD-L1表达患者的中位总生存期分别高于65岁以上、鳞癌、低分化、无PD-L1表达患者(P<0.05)。PD-L1低表达患者的中位生存期明显高于高表达患者(P=0.04)。 结论:根据中国NSCLC的PD-L1免疫组化检测标准专家共识,我们检测了NSCLC中的PD-L1表达,进而筛选出抗PD-1/PD-L1治疗的优势人群。同时检测了EGFR基因突变,EGFR突变也与PD-1和PD-L1表达呈负相关。基于PD-L1表达和EGFR突变状态,可能使NSCLC患者受益于个体化治疗。同时,65岁以下、腺癌、高分化和中分化、PD-L1低表达的患者预后相对较好,为NSCLC的预后评估提供参考。
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