摘要
目的程序性死亡配体-1 （programmed cell death-ligand 1, PD-L1 ）是表达于多种肿瘤细胞表面的抑制分子，它在介导乳腺癌肿瘤细胞免疫逃逸过程中发挥重要作用。本研究采用Meta分析评价方法，探讨PD-L1表达与乳腺癌临床病理学特征及预后的相关性。方法检索PubMed、EMBASE、Cochrane Library database、中国知网、万方和维普等数据库，收集国内外自数据库建立截止至2018—02公开发表的关于PD-L1表达与乳腺癌临床意义及预后的相关病例对照研究，2位研究者按纳入排除标准筛选文献，并用Newcastle-Ottawa Scale（NOs）量表进行文献质量评价，采用Review Manager5．3进行Meta分析，Statal2．0评估文献的发表偏倚。结果共纳入10个病例对照研究，包含2864例患者。Meta分析显示，PD-L1高表达与乳腺癌患者的总生存率（HR=2．10，95％CI为1．19～3．71，P=0．010）和无病生存率（HR=1．36，95％CI为1．03～1．79，P=0．030）降低有关；在PD-L1表达方面，乳腺癌组织比对照组织表达高（0R=5．87，95％CI为3．31～10．43，P〈0．001），三阴性乳腺癌（triple-negative breast cancer, TNBC）相对于非三阴乳腺癌（non-triple negative breast cancer,non-TNBC）组织表达高（OR=3．76，95％CI为1．38-10．23，P=0．010）；PD-L1的表达差异与淋巴结转移（OR=0．72，95％CI为0．53-0．96，P=0．03）、组织病理学分级（OR=0．55，95％CI为0．40-0．75，P=0．001）及ER表达（0R=3．27，95斯CI为1．25～8．55，P=0．020）有关，而与PR表达（OR=3．08，95％CI为0．98-9．69，P=0．050）和HER2（OR=0．87，95％CI为0．59～1．29，P=0．490）表达无关。结论PD-L1与乳腺癌的淋巴结转移、临床病理学分级及ER表达密切相关，且为乳腺癌预后的负性影响因素。
OBJECTIVE Programmed cell death-ligand 1（PD-L1） is the suppressor expressed on the surface of sev- eral kinds of tumor cells, which plays an important role in immune escape of malignancies. This study investigated the cor- relation of PD-L1 expression with clinicopathological features and prognosis in breast cancer through a meta-analysis. METHODS PubMed, EMBASE,Cochrane Library Database,CNKI,Wan Fang and VIP databases were searched for col- lecting retrospective cohort studies of the association between PD-L1 expression and breast cancer, up to Feb 1st, 2018. Literature screening was operated by two researchers through the inclusion/exclusion criteria. Meta analysis was carried out by Review Manager 5.3 software. Newcastle-Ottawa Scale（NOS） was used for evidence quality assessment,and publi- cation bias was evaluated by the Stata 12.0 software. RESULTS Ten studies （involving 2 864 patients） were included in the meta-analysis. Results suggested that PD-L1 positive expression was associated with worse OS （HR= 2.10,95 % CI： 1.19-3.71,P=0. 010） and DFS （HR=1. 36,95MCI：1.03-1.79,P=0. 030）. The expression level of PD-L1 in breast cancer and triple negative breast cancer tissues was especially higher than that of control tissues and non-triple negative breast cancer tissues. Moreover, higher PD-L1 expression was related with lymph node metastasis （OR= 0. 72,95 % CI： 0. 53-0. 96,P=0. 030） ,histologic grade （OR=0.55,95%CI：0.40-0. 75,P〈0. 001） and ER expression （OR= 3.27, 95%CI：1.25- 8. 55, P= 0. 020）. There was no significant correlation with PR （OR= 3. 08,95%CI： 0. 98- 9. 69,P=0. 050） and HER-2 expression （OR=0. 87,95% CI： 0. 59-1. 29,P=0. 490）. CONCLUSION The meta-analysis shows that PD-L1 higher expression is associated with worse survival in breast cancer and is more common in patients with lymph nodes metastasis,higher histologic grade or negative ER expression.
作者
李佳
敖宁
乔东波
张秀茹
LI Jia;AO Ning;QIAO Dong bo;ZHANG Xiu-ru(Department of Pathology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2018年第19期1395-1402,共8页
Chinese Journal of Cancer Prevention and Treatment
