摘要
目的探讨早期三阴性乳腺癌中程序性死亡蛋白配体1(PD-L1)的表达情况及其对预后的影响,为临床治疗决策提供帮助。方法纳入2009年6月至2015年11月于中国医学院科院肿瘤医院行手术治疗的早期三阴性乳腺癌患者205例,采用免疫组化方法检测癌组织中雌激素受体、孕激素受体、人表皮生长因子受体2、SPARC、雄激素受体和PD-L1的表达状态。通过电子病历系统收集患者的临床资料,通过随访获得患者的复发和生存资料。采用Kaplan-Meier法进行生存分析,患者生存时间影响因素分析采用单因素和多因素Cox比例风险模型进行回归分析。基于多因素Cox回归分析结果建立早期三阴性乳腺癌患者的无病生存率列线图预测模型和总生存率列线图预测模型。结果205例患者中,PD-L1阳性90例,占43.9%。中位随访63个月,出现复发转移37例,死亡16例。205例患者的5年无病生存率为86.1%(95%CI:81.4%~90.8%),5年总生存率为93.6%(95%CI:91.0%~97.6%)。单因素Cox回归分析显示,PD-L1表达、淋巴结转移与早期三阴性乳腺癌患者的无病生存时间(DFS)及总生存时间(OS)有关(均P<0.05)。多因素Cox回归分析显示,PD-L1表达是早期三阴性乳腺癌患者DFS的独立影响因素,PD-L1表达阳性者DFS有明显获益(HR=0.31,95%CI:0.13~0.73);淋巴结转移是早期三阴性乳腺癌患者OS的独立影响因素,淋巴结转移阳性的患者OS明显缩短(HR=3.2495%CI:1.15~9.17)。纳入PD-L1表达、淋巴结转移情况、绝经状态、Ki-67指数和辅助化疗方案建立早期三阴性乳腺癌患者的1、3年无病生存率列线图预测模型和总生存率列线图预测模型,C指数分别为0.698和0.748。结论PD-L1表达情况可以作为预测早期三阴性乳腺癌患者生存的有效标志物,PD-L1阳性患者的DFS明显延长,OS表现出延长趋势。所建立的列线图预后预测模型对早期三阴性乳腺癌患者的术后辅助化疗有一定的参考价值。
Objectives To find the prognostic factors related to early triple-negative breast cancer to optimize the therapeutic strategies,and explore the influence of programmed cell death ligand-1(PD-L1)expression in early triple-negative breast cancer on its prognosis,so as to provide support for clinical treatment decisions.Methods Early triple-negative breast cancer patients treated at the National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences during 1st June,2009 and 31st Oct,2015 were enrolled in this study.All the clinicopathological data of patients were collected,and the paraffin sections of the surgical specimens were stained with estrogen receptor,progesterone receptor,human epidermal growth factor receptor-2,secreted protein acidic and rich in cysteine(SPARC),androgen receptor,PD-L1 and other antibodies by the immunohistochemical method.Kaplan-Meier survival and Cox regression curves were used for survival analysis of relevant clinical and pathological results and nomogram survival prediction models were established to explore the influence of relevant factors on the prognosis.Results A total of 205 patients with triple-negative breast cancer were enrolled.Ninety patients(43.9%)were PD-L1 positive.The median follow-up time was 63 months.Thirty-seven patients were relapsed or recurrent and 16 patients were dead.The 5-year disease-free survival(DFS)rate and overall survival(OS)rate were 86.1%(95%CI:81.4%-90.8%)and 93.6%(95%CI:91.0%-97.6%),respectively,in the general population.Univariate Cox regression analysis showed that PD-L1 expression and lymph node metastasis were correlated with DFS and OS(P<0.05).In multivariate analysis,PD-L1 expression was an independent influencing factor of DFS,with PD-L1 positive patients possessing a significant survival benefit in DFS(HR=0.31,95%CI:0.13-0.73).Lymph node metastasis was an independent influencing factor of OS,and OS was significantly shortened in patients with positive lymph node metastasis(HR=3.24,95%CI:1.15-9.17).PD-L1,lymph node metastasis,menopausal status,Ki-67 index and adjuvant chemotherapy regimen were included to establish the 1-and 3-year DFS and OS nomogram prediction models,resulting in C indices of 0.698 and 0.748,respectively.Conclusions PD-L1 expression is a predictive biomarker of good prognostic factor in triple-negative breast cancer patients.DFS is significantly prolonged in PD-L1 positive patients and OS also shows a prolongation trend.The nomogram prognosis prediction models have reference values for adjuvant chemotherapy in this patient group.
作者
岳健
王雪
朱安婕
王鼎元
高崧淋
胡南林
司怡然
郑方超
巨洁
王征
袁芃
Yue Jian;Wang Xue;Zhu Anjie;Wang Dingyuan;Gao Songlin;Hu Nanlin;Si Yiran;Zheng Fangchao;Ju Jie;Wang Zheng;Yuan Peng(Department of VIP Medical Services,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Medical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Breast Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2023年第11期948-954,共7页
Chinese Journal of Oncology
基金
希思科临床肿瘤学研究基金(Y-HR2020QN-0306)。
关键词
三阴性乳腺肿瘤
程序性死亡蛋白配体1
列线图
生存
Triple-negative breast neoplasms
Programmed cell death ligand-1
Nomogram
Survival
作者简介
通信作者:袁芃,Email:yuanpeng01@hotmail.com。
