负性共刺激分子PD-L1在非肌层浸润性膀胱癌的表达及其对术后膀胱灌注治疗的影响  

Effect of Negative Costimulatory Molecule PD-L1 on Intravesical Instillation Therapy in Non-muscle Invasive Bladder Cancer after Surgery

作　　者：刘志华[1] 叶云林[2] 卞军[3] 赖德辉[4] 郑伏甫[1] 戴宇平[1] 

机构地区：[1]中山大学附属第一医院泌尿外科,广东广州510080 [2]中山大学附属肿瘤医院泌尿外科,广东广州510060 [3]南方医科大学附属第三医院泌尿外科,广东广州510030 [4]广州医科大学附属第五医院泌尿外科,广东广州510700

出　　处：《中山大学学报（医学科学版）》2015年第2期221-226,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81072101)

摘　　要：【目的】探讨负性共刺激分子PD-L1在非肌层浸润性膀胱癌的表达及其对术后膀胱灌注治疗的影响。【方法】采用免疫组化法染色方法检测131例膀胱癌组织标本(均经病理诊断确认为非肌层浸润性膀胱癌)和10例正常膀胱黏膜组织标本的PD-L1表达情况,所有膀胱癌患者术后均予表柔比星或沙培林膀胱灌注,详细记录肿瘤复发、进展的时间和预后情况。【结果】PD-L1在正常膀胱黏膜组织不表达0(0/10),在非肌层浸润性膀胱癌组织阳性率为56.5%(74/131),P=0.000。PD-L1的表达与病理分期相关,p Ta、p T1的PD-L1阳性率分别为35.1%(13/37)、60.6%(57/94),P=0.008。PD-L1阳性的患者肿瘤复发率和肿瘤进展率均高于PD-L1阴性的患者,复发率分别为37.8%和12.3%,进展率分别为10.8%和3.5%(P<0.05);PD-L1阳性的患者术后灌注表柔比星预防肿瘤复发和进展的疗效优于沙培林,复发率分别为28.8%和51.7%,进展率分别为6.5%和17.2%(P<0.05);而PD-L1阴性患者表柔比星和沙培林两种治疗方案的疗效无明显差异,复发率分别为9.6%和15.4%,进展率分别为3.2%和3.8%(P>0.05)。【结论】负性共刺激分子PD-L1在非肌层浸润性膀胱癌表达水平与病理分期密切相关,根据PD-L1的表达情况选择术后辅助性膀胱灌注治疗药物有助于提高治疗效果。【Objective】 To investigate the expression of negative costimulatory molecule PD-L1 in non-muscle invasive bladder cancer（NMIBC） and its effect on intravesical instillation therapy after surgery. 【Methods】 10 normal bladder tissues and 131 bladder cancer tissues were available from patients underwent TUR-Bt at our institution between January 2006 and March 2013. NMIBC patients were administrated with epirubicin or Picibanil for adjuvant intravesical instillation therapy. Immunohistochemistry staining was used to detect the PD-L1 expression in tumor and normal specimens. All data of the time and number of tumor recurrence and progression were recorded. 【Results】 PD-L1 expression were negative in normal bladder 0（0 / 10）,comparing with 56.5%（74 / 131）in NMIBC（P = 0.000）. The expression of PD-L1 in p Ta and p T1 bladder cancer were 35.14%（13 / 37）and 60.64%（57 / 94）,respectively（P = 0.008）. The tumor recurrence and progression rates in PD-L1（＋） patients were 37.8% and 10.8%,which were higher than 12.3% and 3.5% in PD-L1（-） patients（P〈0.05）.Those who treated with epirubicin showed a significant advantage inpreventing tumor recurrence and progression comparing with Picibanil（P〈0.05）. However, the difference was not significant between epirubicin and Picibanil in PD-L1（-） patients（P〉0.05）. 【Conclusions】 Expression of negative costimulatory molecule PD-L1 in NMIBC is significantly correlated with pathologic stage and prognosis. Detecting the PD-L1 might help determine the optimal instillation agents for NMIBC patients.

关 键 词：非肌层浸润性膀胱癌 PD-L1 膀胱灌注治疗 肿瘤免疫逃逸 

分 类 号：R73[医药卫生—肿瘤]