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Received:January 06, 2020 Published Online:October 20, 2020
Received:January 06, 2020 Published Online:October 20, 2020
中文摘要: 目的 通过检测宫颈鳞癌组织中的乏氧诱导因子(HIF)-1α和程序性细胞死亡蛋白配体(PD-L1)的表达,探讨二者在宫颈癌组织中的临床意义。
方法 研究对象为河北北方学院附属第一医院2013年1月至2014年12月经宫颈活检病理组织学证实为宫颈鳞癌、同步放化疗后的患者85例,采用免疫组化法检测病理标本中HIF-1α和PD-L1表达;分析HIF-1α和PD-L1表达与临床病理特征的关系;评定和比较放化疗结束后1个月的疗效;用直接计算法比较5年生存率。
结果 HIF-1α和PD-L1在宫颈癌组织的阳性表达率分别为75.29%和67.06%,二者成正相关 (r=0.237,P=0.029)。85例宫颈癌患者中,临床国际妇产科联盟（FIGO）分期高、有淋巴结转移患者的HIF-1α、PD-L1阳性表达率高于临床FIGO分期低、无淋巴结转移患者,肿瘤直径>4 cm患者HIF-1α阳性表达率高于肿瘤直径≤4 cm患者(P<0.05,P<0.01);不同年龄、不同鳞状上皮细胞癌抗原(SCC-Ag)表达量患者的HIF-1α阳性率以及不同年龄、不同肿瘤直径、不同SCC-Ag表达量患者的PD-L1阳性率,差异均无统计学意义 (P均>0.05) 。HIF-1α阴性表达者放化疗近期有效率高于阳性表达者 (85.71% vs 62.50%,P=0.047);PD-L1阴性表达者放化疗近期有效率稍高于阳性表达者,但差异无统计学意义 (71.43% vs 66.67%,P=0.658)。85例中位随访时间60个月,5年总生存率为62.35%;HIF-1α阴性者5年生存率高于HIF-1α阳性者 (85.71% vs 54.69%,P=0.011);PD-L1阴性者5年生存率高于PD-L1阳性者 (78.57% vs 54.39%,P=0.031)。
结论 HIF-1α、PD-L1的表达情况可影响宫颈癌放化疗近期疗效,或可作为预测宫颈癌预后的参考指标。
Abstract:Objective To investigate the expressions of hypoxia inducible factor(HIF)-1α and programmed cell death protein ligand-1 (PD-L1) in cervical squamous cell carcinoma tissues and their clinical significance.
Methods Immune-histochemistry was used to detect HIF-1α and PD-L1 in pathological specimen of 85 patients with cervical squamous cell carcinoma confirmed by histopathology and with concurrent chemo-radiotherapy from January 2013 to December 2014.The relationship between HIF-1α and PD-L1 expressions and clinicopathological features was analyzed;the curative effect was evaluated and compared in patients with different expression levels of HIF-1α and PD-L1 one month after concurrent chemo-radiotherapy.The 5-year survival rate was observed and compared by direct calculation.
Results The positive expression rates of HIF-1α and PD-L1 in cervical cancer were 75.29% and 67.06%,respectively.There was a positive correlation between them (r=0.237,P=0.029).The positive expression rates of HIF-1α and PD-L1 in patients with high International Federation of Gynecology and Obstetrics( FIGO )stage,lymph node metastasis were significantly higher than those in patients with low clinical FIGO stage,no lymph node metastasis;and the positive expression rate of HIF-1α in patients with tumor diameter> 4 cm was higher than that in patients with tumor diameter ≤4 cm (P<0.05,P<0.01).There were no significant differences in positive rates of HIF-1α in patients with different ages and squamous cell carcinoma antigen (SCC Ag) expression levels,as well as the positive rates of PD-L1 in patients with different ages, tumor diameters and SCC-Ag expression levels (all P>0.05).The short-term effective rate of chemo-radiotherapy in patients with negative HIF-1α expression was higher than that in positive HIF-1α expressions (85.71% vs 62.50%, P=0.047); the short-term effective rate of chemo-radiotherapy in patients with negative PD-L1 expression was slightly higher than that of positive PD-L1 expression,but the difference was not statistically significant (71.43% vs 66.67%, P=0.658).
With a mean follow-up of 60 months,the 5-year overall survival rate was 62.35%.The 5-year survival rates in patients with negative expressions of HIF-1α(85.71% vs 54.69%,P=0.011 ) and PD-L1(78.57% vs 54.39%,P=0.031) were statistical higher than those in patients with positive expressions of HIF-1α and PD-L1.
Conclusion The expressions of HIF-1 α and PD-L1 can affect the short-term efficacy of chemo-radiotherapy and can be used as a reference index to predict the prognosis of cervical cancer.
keywords: Cervical cancer Hypoxia inducible factor-1α Programmed cell death protein ligand-1 Concurrent chemo-radiotherapy Clinicopathologic features Short-term efficacy 5-year survival rate
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基金项目:河北省医学科学研究重点课题(20180816)
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