人类表皮生长因子受体-2、血管内皮生长因子-A和细胞程序性死亡-配体1在胆囊癌中的表达及其临床意义  

Expression and significance of human epidermal growth factor receptor 2,vascular endothelial growth factor-A,and programmed death-ligand 1 in gallbladder cancer

作　　者：杨阳 张文华[1] 王万祥[1] YANG Yang;ZHANG Wenhua;WANG Wanxiang(Department of Hepatobiliary,Pancreatic and Splenic Surgery,The Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,China)

机构地区：[1]内蒙古医科大学附属医院肝胆胰脾外科,呼和浩特010030

出　　处：《临床肝胆病杂志》2025年第4期703-712,共10页Journal of Clinical Hepatology

摘　　要：目的分析人类表皮生长因子受体-2(HER-2)、血管内皮生长因子-A(VEGF-A)和细胞程序性死亡-配体1(PD-L1)在胆囊癌中的表达情况,探究3种标志物对于患者预后的临床意义,为后续的研究提供理论支持。方法收集2017年12月—2019年9月于内蒙古医科大学附属医院行胆囊癌根治术,且术后病理证实为胆囊癌的55例患者术后标本及临床资料。利用免疫组化染色法检测患者癌组织及癌旁组织中HER-2、VEGF-A、PD-L1的表达情况,分析3种标志物表达情况与患者临床特征的关系,以及对患者预后的影响。符合正态分布的计量资料2组间比较采用成组t检验;不符合正态分布的计量资料2组间比较采取Mann-Whitney U检验。计数资料组间比较采用χ2检验。采用Cox回归模型对患者预后影响因素进行单因素、多因素分析。使用Kaplan-Meier曲线分析患者的预后情况,并通过Log-rank检验比较差异。结果55例患者的癌组织中HER-2高表达15例(27.2%)、VEGF-A高表达23例(41.8%)、PD-L1高表达18例(32.7%),与癌旁组织比较,差异均有统计学意义(P值均<0.05)。不同HER-2表达组在肿瘤位置方面的差异具有统计学意义(P<0.05),不同VEGF-A表达组在肿瘤最大直径、肿瘤分化度、肿瘤位置、N分期、周围器官侵犯、脉管侵犯方面的差异均有统计学意义(P值均<0.05),不同PD-L1表达组在周围器官侵犯、脉管侵犯、疾病分期方面的差异均有统计学意义(P值均<0.05)。Cox多因素分析结果显示,术前CA19-9水平、HER-2表达为影响患者总生存期的独立危险因素(P值均<0.05),术前CA19-9水平、肿瘤最大直径、N分期、VEGF-A、PD-L1表达为患者无进展生存期的独立影响因素(P值均<0.05)。Kaplan-Meier分析结果显示,HER-2高表达患者的总生存期和无进展生存期相比于HER-2低表达患者均有显著差异(P值均<0.05)。结论HER-2、VEGF-A、PD-L1对于胆囊癌患者的临床意义重大,是潜在的靶向治Objective To investigate the expression and prognostic significance of human epidermal growth factor receptor 2(HER-2),vascular endothelial growth factor-A(VEGF-A),and programmed death-ligand 1(PD-L1)in gallbladder cancer,and to provide a theoretical basis for subsequent research.Methods A retrospective analysis was performed for the postoperative specimens and clinical data of 55 patients who underwent radical cholecystectomy for gallbladder cancer and had pathologically confirmed gallbladder adenocarcinoma in The Affiliated Hospital of Inner Mongolia Medical University from December 2017 to September 2019.Immunohistochemical staining was used to measure the expression levels of HER-2,VEGF-A,and PD-L1 in cancerous tissue and paracancerous tissue.The association between the expression of these three markers and clinical features were analyzed,as well as their impact on the prognosis of patients.The independent-samples t test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.The Cox regression model was used to perform the univariate and multivariate analyses of clinical factors.The Kaplan-Meier curve was used to analyze the prognosis of patients,and the Log-rank test was used for comparison.Results Among the 55 patients,15 patients(27.2%)had a high expression level of HER-2 in cancerous tissue,23(41.8%)had a high expression level of VEGF-A,and 18(32.7%)had a high expression level of PD-L1,with significant differences compared with the paracancerous tissue(all P<0.05).There was a significant difference in tumor location between the groups with different expression levels of HER-2(P<0.05);there were significant differences in maximum tumor diameter,degree of tumor differentiation,tumor location,N stage,peripheral organ invasion,and vascular invasion between the groups with different expression levels

关 键 词：胆囊肿瘤 人类表皮生长因子受体-2 血管内皮生长因子-A 细胞程序性死亡-配体1 

分 类 号：R735.8[医药卫生—肿瘤]