原发性胃淋巴上皮瘤样癌的临床及免疫学特征分析

目的比较原发性胃淋巴上皮瘤样癌(gastric lymphoepithelioma-like carcinoma, GLELC)和胃腺癌的临床特征,分析GLELC组织免疫学指标变化。方法原发性GLELC患者18例为GLELC组,同期诊治胃腺癌患者28例为胃腺癌组。比较2组临床资料及手术切除组织中程序性死亡受体-1(programmed cell death-1, PD-1)、程序性死亡受体配体-1(programmed cell death ligand-1, PD-L1)表达情况;比较GLELC组癌组织CD3⁺、CD4⁺、CD8⁺、CD20⁺细胞比率。结果 GLELC组TNM分期Ⅰ~Ⅱ期比率(77.78%)高于胃腺癌组(35.71%)(P<0.05),Ⅱ、Ⅲ期者肿瘤直径(5.00±2.10)cm、(7.50±0.91)cm]大于胃腺癌组(2.80±1.30)、(5.46±2.89)cm](P<0.05),淋巴结转移比率(38.89%)低于胃腺癌组(71.43%)(P<0.05),PD-L1阳性表达率(88.89%)高于胃腺癌组(21.43%)(P<0.05),PD-1阳性表达率(22.22%)与胃腺癌组(17.86%)比较差异无统计学意义(P>0.05)。GLELC组癌组织中CD3⁺T淋巴细胞比率(76.39±4.13)%]高于CD20⁺B淋巴细胞比率(18.06±3.49)%](t=45.762,P<0.001),CD8⁺T淋巴细胞比率48.89±6.54)%]高于CD4⁺T淋巴细胞比率(27.50±3.54)%](t=12.202,P<0.001)。结论与胃腺癌相比,原发性GLELC肿瘤分期较低,肿瘤直径较大,淋巴结转移较少,癌组织PD-L1呈高表达,且淋巴细胞浸润以CD3⁺、CD8⁺T淋巴细胞为主。

Clinical and immunological characteristics of primary gastric lymphoepithelioma-like carcinoma

Objective To compare the clinical characteristics of primary gastric lymphoepithelioma-like carcinoma(GLELC) and gastric adenocarcinoma, and to analyze the changes of immunological indicators in GLELC tissue. Methods The clinical data and the expressions of programmed cell death-1(PD-1) and programmed cell death ligand-1(PD-L1) in the resected cancer tissues were compared in 18 patients with primary GLELC(GLELC group) and 28 patients with gastric adenocarcinoma(gastric adenocarcinoma group). The percentages of CD3⁺, CD4⁺, CD8⁺ and CD20⁺cells in the cancer tissues were compared in GLELC group. Results The percentage of TNM stages Ⅰ-Ⅱ was higher in GLELC group(77.78%) than that in gastric adenocarcinoma group(35.71%)(P<0.05), the diameters of tumors in TNM stage Ⅱ and Ⅲ were longer in GLELC group((5.00±2.10),(7.50±0.91) cm) than those in gastric adenocarcinoma group((2.80±1.30),(5.46±2.89) cm)(P<0.05), the rate of lymph node metastasis was lower in GLELC group(38.89%) than that in gastric adenocarcinoma group(71.43%)(P<0.05), the positive rate of PD-L1 was higher in GLELC group(88.89%) than that in gastric adenocarcinoma group(21.43%)(P<0.05), and the positive rate of PD-1 expression showed no significant difference between two groups(22.22% vs. 17.86%)(P>0.05). The ratio of CD3⁺T lymphocytes((76.39±4.13)%) was higher than that of CD20⁺ B lymphocytes((18.06±3.49)%)(t=45.762, P<0.001) in GLELC group, and the percentages of CD8⁺ T lymphocytes((48.89±6.54)%) was significantly higher than that of CD4⁺ T lymphocytes((27.50±3.54)%)(t=12.202, P<0.001). Conclusion Compared with gastric adenocarcinoma, the primary GLELC has lower stage, longer diameter, less lymph node metastasis, more highly expressed PD-L1 in cancer tissue, and more infiltrated CD3⁺T and CD8⁺T lymphocytes.