非小细胞肺癌患者肺静脉血循环肿瘤细胞数量及程序性死亡受体配体-1表达与预后的关系  

Correlations of pulmonary venous circulating tumor cells and programmed death receptor ligand-1 with prognosis of patients with non-small cell lung cancer

作　　者：孔祥楠[1] 张茹 宋欣新[1] 吕金燕[2] 金倩晨 李佳默 王刚[2] KONG Xiang-nan;ZHANG Ru;SONG Xin-xin;LYU Jin-yan;JIN Qian-chen;LI Jia-mo;WANG Gang(Department of Pathology,Zhongshan Hospital of Dalian University,Dalian,Liaoning 116001,China;Department of Oncology,Zhongshan Hospital of Dalian University,Dalian,Liaoning 116001,China)

机构地区：[1]大连大学附属中山医院病理科,辽宁大连116001 [2]大连大学附属中山医院肿瘤科,辽宁大连116001

出　　处：《中华实用诊断与治疗杂志》2021年第11期1100-1103,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：辽宁省自然科学基金(20170540559)。

摘　　要：目的观察非小细胞肺癌(non-small cell lung cancer, NSCLC)患者肺静脉血循环肿瘤细胞(circulating tumor cell, CTCs)数量及程序性死亡受体配体-1(programmed death ligand-1, PD-L1)表达变化,探讨其与NSCLC预后的相关性。方法 89例行手术治疗的Ⅰ~Ⅲa期NSCLC患者,采用荧光细胞化学染色法检测肺静脉血、外周血CTCs数量,采用荧光染色标记法检测CTCs中PD-L1表达。随访2年,根据患者是否出现疾病进展分为进展组和未进展组,比较2组患者临床资料,肺静脉血、外周血CTCs数量及CTCs中PD-L1表达;多因素Cox回归分析NSCLC患者疾病进展的影响因素。结果随访至2020年9月30日,6例失访,完成随访的83例患者中,29例出现疾病进展(进展组),54例未出现疾病进展(未进展组)。进展组临床分期Ⅲa期(68.97%)、病灶≥3 cm^(3)(62.07%)、淋巴结转移数目≥3枚(68.97%)比率均高于未进展组(44.44%、37.04%、44.44%)(P<0.05),性别比例、年龄、病理类型、病灶位置、手术方式及切缘阳性、术后化疗比率与未进展组比较差异均无统计学意义(P>0.05)。进展组肺静脉血CTCs数量[(9.13±1.22)个/mL]及CTCs中PD-L1表达(1.31±0.40)高于未进展组[(7.31±1.58)个/mL、0.82±0.27](P<0.05),外周血CTCs数量及CTCs中PD-L1表达与未进展组比较差异均无统计学意义(P>0.05)。病灶≥3 cm^(3)(HR=5.526,95%CI:1.489~20.382,P=0.010)、临床分期Ⅲa期(HR=3.859,95%CI:1.056~14.104,P=0.041)、肺静脉血CTCs数量(HR=11.207,95%CI:1.391~90.270,P=0.023)、肺静脉血CTCs中PD-L1表达(HR=722.533,95%CI:658.026~3 331.415,P=0.009)是NSCLC患者疾病进展的影响因素。结论 NSCLC患者肺静脉血CTCs数量及CTCs中PD-L1表达增高提示疾病进展。Objective To observe the changes of programmed death receptor ligand-1(PD-L1) and the count of circulating tumor cells(CTCs) in the pulmonary vein of patients with non-small cell lung cancer(NSCLC), and to investigate the correlation of PD-L1 with prognosis. Methods The counts of CTCs in pulmonary vein and peripheral blood were detected with fluorescent cytochemical staining technique in 89 patients with stage Ⅰ-Ⅲa NSCLC during operation, and fluorescent staining labeling method was used to detect the expression of PD-L1 in CTCs. The patients were followed up for 2 years and divided into progressive group and non-progressive group. The clinical data, CTCs counts in pulmonary vein and peripheral blood, and the expression of PD-L1 in CTCs were compared between two groups. Multivariate Cox regression was used to analyze the influencing factors of disease progression in NSCLC patients. Results In 2-year follow-up till September 30, 2020, 6 cases were lost. Of 83 patients who completed the follow-up, 29 were progressive. The percentages of clinical stage Ⅲa, lesions ≥3 cm;, and the number of lymph node metastases ≥3 were higher in progressive group(68.97%, 62.07%, 68.97%) than those in non-progressive group(44.44%, 37.04%, 44.44%)(P<0.05), and there were no significant differences in gender ratio, age, pathological type, lesion location, operation method, positive rate of resection margin, and postoperative chemotherapy between two groups(P>0.05). The count of CTCs and the expression of PD-L1 in CTCs in pulmonary vein were grater in progressive group [(9.13±1.22) cells/mL, 1.31±0.40] than those in non-progressive group [(7.31±1.58) cells/mL, 0.82±0.27] (P<0.05),while the count of CTCs and the expression of PD-L1 in CTCs in peripheral blood showed no significant differences between two groups(P>0.05).The lesions≥3 cm;(HR=5.526,95%CI:1.489-20.382,P=0.010),clinical stage Ⅲa(HR=3.859,95%CI:1.056-14.104,P=0.041),the count of CTCs in pulmonary vein(HR=11.207,95%CI:1.391-90.270,P=0.023),and the expression o

关 键 词：非小细胞肺癌 循环肿瘤细胞 程序性死亡受体配体-1 预后 

分 类 号：R734.2[医药卫生—肿瘤]