头颈部原发性黏膜恶性黑色素瘤患者PD－L 1表达及其临床相关因素分析

目的：探讨头颈部原发性黏膜恶性黑色素瘤患者程序性细胞死亡配体1（PD－L1）表达及其临床意义。方法：研究采用免疫组化检测45例头颈部原发性黏膜恶性黑色素瘤样本PD－L1表达，分析其表达与患者临床病理学特征及疾病预后的关系。结果：所有患者均接受手术切除治疗联合干扰素治疗。随访患者5年生存率为44．4％（20／45），平均生存期为51个月，无复发生存期为23个月。免疫组化染色证实57．8％（26／45）肿瘤样本为 PD －L1高表达，显著多与临近非肿瘤组织（P＝0．0037）。PD－L1表达与患者年龄（P＝0．09）、性别（P＝0．16）、肿瘤分布（P＝0．08）无关，而PD－L1阳性患者的无复发生存期显著短于阴性患者（P＝0．027）。多变量分析证实PD－L1高表达是头颈部原发性黏膜恶性黑色素瘤患者预后不良独立标志物。结论：PD－L1高表达与头颈部原发性黏膜恶性黑色素瘤进展和预后不良密切相关，可以作为该疾病的预后标志物。

Clinical relevance of PD-L1 expression in primary mucosal malignant melanoma of the head and neck

Objective:To identify the PD-L1 expression pattern in primary mucosal malignant melanoma,to in-vestigate clinicopathological and outcome associations.Methods:We assessed PD-L1 expression using immunohisto-chemical staining in 45 tumor samples from patients with primary mucosal melanoma and correlated expression status with clinicopathological and outcome data.Results:All patients had undergone surgery combined with interferon thera-py.The probability of 5 -year overall survival was 44.4%.The mean overall survival was 5 1 months and the mean re-currence-free survival was 23 months.Immunohistochemical staining showed PD-L1 expression was in 57.8%(26/45)of mucosal melanoma.In contrast,prominent PD-L1 staining was detected in 6.7%(3/45)of tissue sections from a control group of cutaneous melanoma (P=0.003 7).PD-L1 expression in mucosal melanoma was not corre-lated with age (P=0.09),gender (P=0.16),localization of the tumor (P=0.08).Interestingly,patients with PD-L1 -positive mucosal melanoma had a significantly longer recurrence -free survival (P=0.027 ).Conclusion:High expression of PD-L1 is associated with poor prognosis as well as clinical progression in primary mucosal malig-nant melanoma.