上尿路尿路上皮癌中程序性死亡配体1的表达及其预后意义

目的：分析程序性死亡蛋白配体1（PD-L1）表达与上尿路尿路上皮癌（UTUC）预后之间的关系。方法：采用免疫组化法检测151 例UTUC行根治性肾输尿管切除术（RNU）患者肿瘤组织中PD-L1的表达；术后进行随访，评估患者预后；分析PD-L1表达与患者预后的相关性。结果：患者中位年龄为52岁，中位随访时间为63 个月，50 例（33%）样本组织中PD-L1表达呈阴性。PD-L1阴性表达与较高的肿瘤病理分期（P =0.04）、较高病变分级（P =0.01）以及淋巴血管侵犯（P ＜0.01）显著相关。Kaplan-Meier生存曲线分析显示PD-L1阴性表达与较差的无瘤生存率（P =0.01）和较差的癌症特异性生存率相关（P =0.01）。多因素Cox回归分析显示PD-L1阴性表达与疾病复发（HR =2.05，95%CI =1.06～3.96，P =0.032）和癌症特异性生存率（HR =2.89，95%CI =1.22～6.82，P =0.024）显著相关。结论：PD-L1阴性表达是UTUC行RNU后癌症复发和肿瘤特异性生存的独立预测因子，表明了将UTUC患者纳入免疫治疗临床试验的必要性。

Expression of programmed-death ligand 1 in upper tract urothelial carcinoma and its prognostic significance

Objective: To analyze the relationship between the expression of programmed-death ligand1 (PD-L1) and the clinicopathological features and prognosis of upper tract urothelial carcinoma (UTUC).Postoperative follow-up was performed to evaluate the prognosis of the patients, and to analyze the correlation between the expression of PD-L1 and the prognosis of the patients. Methods: Immunohistochemistry (IHC) was used to detect the expression of PD-L1 in 151 patients with UTUC radical nephroureterectomy (RNU). Results:The median age of the patients was 52 years old (range: 36-74 years old). The median follow-up time was 63months (range: 1-100 months), and the expression of PD-L1 was negative in 50 (33%) of the samples. Negative PD-L1 expression was significantly associated with higher tumor pathologic stage (P=0.04), higher lesion grade(P=0.01), and lymphovascular invasion (P<0.01). Kaplan-Meier survival curve analysis showed that PD-L1 negative expression was associated with poor tumor-free survival (P=0.01) and poor cancer-specific survival(P=0.01). Multivariate Cox regression analysis showed that negative PD-L1 expression was significant associated with disease recurrence (HR=2.05, 95%CI=1.06-3.96, P=0.032) and cancer-specific mortality (HR=2.89, 95%CI= 1.22-6.82, P=0.024), after adjusting for tumor pathological stage, lesion grade, lymph node metastasis, and lymphovascular invasion. Conclusion: Negative PD-L1 expression is an independent predictor of cancer recurrence and tumor-specific survival after UTUC radical nephroureterectomy, indicating the necessity of incorporating UTUC patients into immunotherapy clinical trials.