摘要
目的 探讨程序性死亡分子1（PD-1）及其配体（PD-L1）和吲哚胺-2,3-双加氧酶1 （IDO-1）在鼻腔鼻窦恶性黑色素瘤（SNM）中的表达及其与患者的临床病理特征和预后的关系.方法采用免疫组织化学的方法对86例未接受放化疗、免疫治疗和分子靶向治疗的SNM样本进行染色,观察PD-1/PD-L1和IDO-1在组织中的表达情况,分析其与临床病理特征及预后的关系.结果 临床病理学分期、脑转移、高龄是SNM预后不良的独立危险因素,无色素组SNM总生存率较有色素组低.PD-1/PD-L1和IDO-1的表达与色素统计学无相关性,与SNM累及部位相关.SNM中PD-1/PD-L1和IDO-1的阳性率分别为47.6%（41/86）、53.5%（46/86）和58.1%（50/86）.PD-1的表达与脑转移有关.PD-1阳性和IDO-1阳性患者的无病生存期均较阴性患者长（P=0.031,P=0.0179）.PD-1阳性和IDO-1阳性患者的无病生存期均较阴性患者长.PD-L1的表达与预后无明显相关性.Ⅲ、ⅣA和ⅣB期PD-1阳性的患者预后较好（P=0.025）,PD-L1阴性和IDO-1阳性患者预后较差（均P〉0.05）.ⅣC期PD-1阳性和IDO-1阴性患者总生存率较低（均P〈0.05）.结论 临床病理学分期、脑转移、年龄和色素可作为预后相关的临床病理学参考指标.PD-1和IDO-1的表达水平可作为评估预后的参考指标.PD-L1在SNM发病及预后判断中的价值有待进一步的研究.
Objective To investigate the correlation between the expression of programmed death-1 （PD-1）,PD ligand-1（PD-L1）,indoleamine 2,3-dioxygenase 1（IDO-1）and clinical parameters in sinonasal malignant mucosal melanoma（SNM）. Methods Samples from 86 SNM patients who did not receive immune-targeted therapy and radio-chemotherapy were analyzed for PD-1,PD-L1,and IDO-1 expression by immunohistochemistry. Results High clinical/pathologic staging, brain metastases and advanced age were independent risk factors of poor prognosis. The overall survival rate of SNM without pigment was lower than that with pigment. PD-1, PD-L1 and IDO-1 expression was not correlated with tumor pigmentation, but correlated with different primary site.PD-1,PD-L1 and IDO-1 were expressed in 47.6%（41/86）, 53.5%（46/86）and 58.1%（50/86）of SNM samples respectively. PD-1 was associated with brain metastasis. Negative expression of PD-1（P=0.031）and IDO-1（P= 0.017 9）correlated with worse disease-free survival. No significant association was found between PD-L1 and prognosis. For stages Ⅲ, ⅣA and ⅣB patients,PD-1 expression was associated with better outcome（P=0.025）,but PD-L1 negative and IDO-1 positive patients hadworse outcome（P〉0.05）. PD-1 positive and IDO-1 negative stage ⅣC patients had poorer overall survival. Conclusions In SNM patients, clinical/pathologic staging, brain metastases, age and pigmentation were prognostic indicator. IDO-1 and PD-1 can also be used as reference to evaluate prognosis. Anti-IDO-1 targeted therapy may be suitable for middle to late stage patients, while advanced stage patients might benefit from anti-PD-1 targeted therapy. PD-1/PD-L1 and IDO-1 may be considered as joint targeted therapy.The predictive value of PD-L1 requires further study.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2017年第11期782-788,共7页
Chinese Journal of Pathology
关键词
黑色素瘤
免疫组织化学
分子靶向治疗
预后
Melanoma
Immunohistochemistry
Molecular targeted therapy
Prognosis
