倾向性评分匹配分析口咽癌PD-L1的表达与HPV感染及预后的相关性研究

目的探讨口咽鳞癌中程序性细胞死亡配体1(PD-L1)与HPV感染状态及患者预后的相关性。方法采用倾向性评分匹配,纳入HPV阳性及HPV阴性口咽癌各50例,对患者进行长期随访,通过免疫荧光检测PD-L1的表达,分析其与HPV感染状态及临床预后的相关性。结果 HPV阳性组及HPV阴性组5年总生存率分别为66%和40%(P=0.003),5年疾病特异性生存率分别为73%和44%(P=0.001)。PD-L1表达率在HPV阳性组较HPV阴性组明显升高(70%vs 42%,P=0.005)。PD-L1与除年龄(P=0.020)外的其他临床病理特征无明显相关性,PDL1阳性为口咽癌独立良好预后因素(DSS,P<0.001;OS,P<0.001)。进一步预后分析提示HPV+/PD-L1+患者较HPV+/PD-L1-者(DSS,P<0.001;OS,P=0.004),HPV-/PD-L1+者(DSS,P=0.010;OS,P=0.047)以及HPV-/PD-L1-者(DSS,P<0.001;OS,P<0.001)具有显著的预后优势。结论 HPV阳性口咽癌患者预后较好,PD-L1在HPV阳性口咽癌中的表达升高,PD-L1阳性可能与HPV阳性口咽癌患者较好的临床预后相关。

Matched-pair analysis of PD-L1 expression,HPV infection and prognosis in oropharyngeal squamous cell carcinoma

Objective To investigate the association of PD-L1 expression,HPV infection status and patient prognosis in oropharyngeal squamous cell carcinoma(OPSCC).Methods The propensity score matching was used to include50 cases of both HPV-positive and HPV-negative OPSCC.We assessed PD-L1 expression using immunofluorescence and its correlation with HPV infection and clinical prognosis was analyzed.Results HPV-positive OPSCC have better prognosis compared to HPV-negative patients(5-year overall survival[OS],66% vs 40%,P=0.003;5-year disease specific survival[DSS],73% vs 44%,P=0.001).PD-L1 expression rate was significantly higher in the HPV-positive OPSCC than in the HPV-negative group(70%vs 42%,P=0.005),with no correlation with clinicopathological factors except age(P=0.020).PD-L1 positivity was an independent prognostic factor for improved OS and DSS(P<0.001,both).Further analysis showed HPV+/PD-L1+ patients had significantly better prognosis compared to HPV+/PDL1-(DSS,P<0.001;OS,P=0.004),HPV-/PD-L1+(DSS,P=0.010;OS,P=0.047)and HPV-/PD-L1-(DSS,P<0.001;OS,P<0.001).Conclusion HPV-positive OPSCC had a significantly better prognosis,and PD-L1 expression is elevated in HPV-positive OPSCC.PD-L1 positivity may be related to the better prognosis of HPV-positive OPSCC。