Abstract
背景与目的肿瘤微环境是肿瘤细胞赖以生存的复杂环境。其中肿瘤相关巨噬细胞(tumor-associated macrophages, TAMs)、肿瘤新生血管及程序性死亡受体1/程序性死亡受体-配体1(programmed cell death protein 1/programmed cell death ligand 1, PD-1/PD-L1)作为关键部分,在肿瘤发生、发展过程中起重要作用,影响患者预后。本研究旨在阐明TAMs、肿瘤新生血管和PD-L1的表达与非小细胞肺癌(non-small cell lung cancer, NSCLC)临床病理特征的相关性,并探讨它们对NSCLC预后的影响。方法收集92例NSCLC患者的临床病理资料及手术标本,采用免疫组化法检测癌组织和癌旁组织中TAMs、肿瘤新生血管和PD-L1的表达,采用配备有Olympus-DP72图像采集系统的Olympus-BX51正置显微镜进行拍照并用Image-pro Plus 6.0软件进行半定量分析。结果癌组织与癌旁组织中TAMs、肿瘤新生血管和PD-L1的表达差异无统计学意义(P > 0.05)。根据肿瘤微环境中各组分的定量表达,可将其分为低、中、高表达组。癌组织中TAMs的低、中和高密度组的中位总生存(overall survival, OS)分别是36个月(95%CI: 25.3-46.7)、26个月(95%CI: 12.2-39.8)和16个月(95%CI: 9.4-22.6),差异具有统计学意义(P=0.016);肿瘤新生血管的低、中和高密度组的中位OS分别为30个月(95%CI: 22.5-37.5)、28个月(95%CI: 18.1-37.9)和25个月(95%CI: 14.6-35.4),差异无统计学意义(P=0.626);PD-L1的低、中和高表达组的中位OS分别为35个月(95%CI: 29.4-40.6),28个月(95%CI: 13.6-42.4)和17个月(95%CI: 10.5-23.5),差异具有统计学意义(P=0.002)。联合低、中和高表达组的中位OS分别为36个月(95%CI: 30.6-41.4)、26个月(95%CI: 19.2-32.8)和9个月(95%CI: 4.4-13.6),差异具有统计学意义(P=0.001)。Cox回归分析结果显示,病理分型、TAMs和PD-L1均为肺癌患者的独立预后因素。结论肿瘤微环境关键成分PD-L1及TAMs的表达与NSCLC患者的预后密切相关。
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