PD-L1与P16在口腔及口咽鳞状细胞癌中的表达及临床意义

发布时间：2018-01-28 03:30

  本文关键词： 人乳头瘤病毒 头颈部鳞状细胞癌 PD-L1 P16　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:近年来,已经证实人乳头瘤病毒感染(Human papillomavirus,HPV)与头颈部鳞状细胞癌(head and neck squamous cell carcinomas,HNSCC)密切相关,P16蛋白状态和人乳头瘤病毒的感染状态具有较好的一致性,即P16蛋白是HPV稳定可靠的替代指标.头颈部鳞状细胞癌,已被认为是一种免疫抑制性疾病,其存在高度的免疫抑制。肿瘤细胞表面的程序性死亡分子的配体(Programmed death ligand-1,PD-L1)的表达被认为是其潜在的发病机制,本文通过检测PD-L1和P16在口咽及口腔鳞状细胞癌中的表达,分析其与临床病理特征及预后之间的联系,探讨PD-L1与P16在口咽及口腔鳞状细胞癌患者中的临床意义。方法:收集大连医科大学附属第二医院于2012年2月至2016年3月收治的口咽及口腔鳞状细胞癌患者39例,全部进行手术并有病理证实;通过免疫组化方法检测P16和PD-L1在组织切片中的表达情况,统计分析二者之间的相关性及其与患者年龄、吸烟史、饮酒史、分期、淋巴结转移情况等临床病理特征之间的关系,并对影响口咽及口腔鳞状细胞癌患者的PFS影响因素进行分析。结果:在39例口咽及口腔鳞状细胞癌的患者中,74.4%的患者PD-L1呈阳性表达,25.6%患者呈阴性表达。其中弱阳性表达有12例,占30.8%,阳性表达有5例,占12.8%,强阳性表达有12例,占30.8%。59.0%的患者P16呈阳性表达,41.0%为阴性表达。在23例P16表达阳性的患者中,21例表达PD-L1,占91.3%,在16例P16阴性的患者中8例表达PD-L1,占50%,两组之间具有统计学意义(P?0.05)。PD-L1的表达与淋巴结转移情况显著相关(P=0.001),与患者的年龄、性别、吸烟、饮酒、T分期、AJCC分期、分化程度、原发肿瘤部位、治疗方案均无统计学差异(P＞0.05)。P16的表达与患者的淋巴结转移情况存在相关性(P=0.032),而与患者的年龄、性别、吸烟、饮酒、T分期、N分期、AJCC分期、分化程度、原发肿瘤部位、治疗方案均无统计学差异(P＞0.05)。通过分析39例患者的中位PFS为23.17个月,得出PD-L1阳性的患者中位PFS为23.38个月,阴性的患者为19.75个月,差异无统计学意义(P＞0.05)。PD-L1与P16均为阳性患者的中位PFS为23.20个月,PD-L1阳性P16阴性的患者中位PFS为17.00个月,PD-L1阴性P16阳性的患者的中位PFS为40.00个月,PD-L1与P16均为阴性的患者中位PFS为19.33个月,差异无统计学意义(P＞0.05)。结论:1、PD-L1在口咽及口腔鳞状细胞癌高度表达,与P16的表达及淋巴结转移情况相关,与患者的PFS未证实相关性。2、P16在口咽及口腔鳞状细胞癌高度表达,与PD-L1的表达及淋巴结转移情况相关,与患者的PFS未证实存在相关性。3、PD-L1在口咽及口腔鳞状细胞癌中的表达与HPV感染相关,HPV阳性的患者中PD-L1表达显著高于HPV阴性的患者。4、PD-L1与P16在口咽及口腔鳞状细胞癌中的共表达与预后未证实相关性,但P16阳性PD-L1阴性的患者预后最好。
[Abstract]:Objective: in recent years, has confirmed that the human papilloma virus infection (Human papillomavirus HPV) head and neck squamous cell carcinoma (head and neck squamous cell carcinomas, HNSCC) is closely related to the infection state of P16 protein and human papilloma virus have good consistency, the P16 protein is a stable and reliable alternative index HPV. Head and neck squamous cell carcinoma, has been considered as a disease of immune suppression, the height of immunosuppression. Tumor cell surface ligand programmed death molecule (Programmed death ligand-1, PD-L1) expression is thought to be the underlying mechanism, through the detection of PD-L1 and P16 expression in oral and oropharyngeal squamous cell carcinoma, analyze its relationship with clinicopathological features and prognosis, to investigate the clinical significance of PD-L1 and P16 in patients with oropharyngeal and oral squamous cell carcinoma. Methods: the collection of Dalian Medical University 39 patients with oral squamous cell carcinoma of the oropharynx and Second Affiliated Hospital from February 2012 to March 2016 were all cases, surgery and pathology; expression by immunohistochemical method to detect P16 and PD-L1 in tissue sections, statistical analysis between the two and their correlation with patient age, smoking history, drinking history, staging the relationship between clinicopathological characteristics and lymph node metastasis, and the influencing factors of PFS effect of oropharynx and oral squamous cell carcinoma patients were analyzed. Results: in 39 cases of oral and oropharyngeal squamous cell carcinoma patients, 74.4% patients with PD-L1 positive expression, negative expression in 25.6% patients. Among them there are weak positive expression in 12 cases, accounting for 30.8%, the positive expression in 5 cases, accounting for 12.8%, a strong positive expression in 12 cases, accounting for 30.8%.59.0% of the patients with P16 positive expression and negative expression in 41%. In 23 cases of patients with P16 positive expression in 21. 渚嬭〃杈綪D-L1,鍗，

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