Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.
Department of Laboratory, Medicine and Pathology, University of Alberta, Edmonton, Canada.
Int J Infect Dis. 2023 Apr;129:285-288. doi: 10.1016/j.ijid.2023.01.043. Epub 2023 Feb 11.
Alveolar echinococcosis (AE) recurrence is one of the major stakes in patients undergoing surgery, the main curative treatment. Preliminary data demonstrated an effect of programmed death-ligand1 (PD-L1) inhibitors on AE proliferation in animals. The current study aimed to analyze the prognostic value of PD-L1 expression in tissue samples of patients with AE undergoing surgery.
A cross-sectional study of patients operated for AE between 2002 and 2017 was performed. Patients with recurrence were matched 1: 2 with patients without recurrence. The matching criteria were PNM staging (P = hepatic localization of the parasite, N = extra-hepatic involvement of neighboring organs, and M = absence or presence of metastasis), resection status, preoperative albendazole treatment, and lesion size. PD-L1 immunohistochemistry staining was performed in surgical liver specimens. The expression of PD-L1 was assessed in immune cells. Disease-free survival was calculated using the Kaplan-Meier method.
Among 68 consecutive patients, eight patients with recurrence were matched to 16 patients without recurrence. PD-L1 was overexpressed in patients with recurrence (recurrence: PD-L1 <1%: one, PD-L1 ≥1%: seven; no recurrence: PD-L1 <1%: nine, PD-L1 ≥1%: seven, P = 0.040). Moreover, patients with lower PD-L1 expression (<1%) showed better median disease-free survival (120 months, 95% confidence interval 104-135 vs 74, 95% confidence interval 44-104, P = 0.050).
These findings highlight the proof of concept of PD-L1 in AE, but further data on its prognostic importance and the role of immune checkpoint blockade as a promising therapeutical strategy are needed.
泡型包虫病（AE）复发是接受手术（主要治疗方法）的患者的主要问题之一。初步数据表明程序性死亡配体 1（PD-L1）抑制剂对动物体内 AE 增殖有影响。本研究旨在分析手术治疗的 AE 患者组织样本中 PD-L1 表达的预后价值。
对 2002 年至 2017 年间接受 AE 手术的患者进行了一项横断面研究。将复发患者与无复发患者 1:2 匹配。匹配标准为 PNM 分期（P=寄生虫肝定位，N=邻近器官的肝外受累，M=无或有转移）、切除状态、术前阿苯达唑治疗和病变大小。在手术肝标本中进行 PD-L1 免疫组织化学染色。评估免疫细胞中 PD-L1 的表达。使用 Kaplan-Meier 方法计算无病生存率。
在 68 例连续患者中，8 例复发患者与 16 例无复发患者相匹配。复发患者 PD-L1 过表达（复发：PD-L1<1%：1 例，PD-L1≥1%：7 例；无复发：PD-L1<1%：9 例，PD-L1≥1%：7 例，P=0.040）。此外，PD-L1 表达较低（<1%）的患者无病生存率更好（120 个月，95%置信区间 104-135 与 74，95%置信区间 44-104，P=0.050）。
这些发现强调了 PD-L1 在 AE 中的概念验证，但需要更多关于其预后重要性和免疫检查点阻断作为一种有前途的治疗策略的作用的数据。
