摘要
目的探讨程序性死亡蛋白配体1(programmed death ligand-1,PD-L1)和血管内皮生长因子(vascular endothelial growth factor,VEGF)联合检测在评估管腔(Luminal)A型乳腺癌患者化疗反应中的潜在应用价值。方法本研究纳入2021年8月—2024年8月河南科技大学第一附属医院收治的130例Luminal A型乳腺癌患者,根据免疫组化染色检测结果将患者分为两组。采用Kaplan-Meier曲线、受试者工作特征(receiver operating characteristic curve,ROC)曲线、局部加权散点图平滑曲线(locally weighted scatterplot smoothing curve,LOWESS)、多元Cox比例风险模型以及亚组分析进一步观察PD-L1与VEGF及临床疗效的关系。结果组1和组2的疾病控制率分别为68.24%和86.67%。PD-L1阳性患者疾病控制率明显低于PD-L1阴性患者(P=0.022)。Cox回归分析表明:PD-L1阴性患者化疗后疾病控制率明显提高(组1作为参考;组2 HR,95%CI:0.98,0.97~0.99,P<0.001);调整年龄、病程、CD3^(+)CD8^(+)的多元Cox回归分析结果表明:PD-L1水平升高,患者化疗中的疾病控制率降低(组1:作为参考;组2:HR,95%CI:0.98,0.98~0.99,P<0.001);进一步调整更多混杂因素后,组2与组1相比,患者疾病控制率仍然降低(HR,95%CI:0.49,0.36~0.67,P<0.001)。Kaplan-Meier曲线表明,PD-L1阳性表达,明显降低了患者化疗后的疾病控制率(Log rankP=0.024)。ROC曲线表明,PD-L1对临床疗效有中等的预测能力,且显著优于CD3^(+)CD8^(+)、CD_(16)^(+)CD_(56)^(+),但明显低于VEGF(De-long testP<0.05)。Lowess曲线表明,随着PD-L1水平增高,临床疗效中疾病控制率显著降低,呈单调递减的关系。亚组分析发现,在CD_(16)^(+)CD_(56)^(+)<16.09和VEGF≥303.10的患者中,PD-L1与疾病控制率的负相关关系更为明显。结论PD-L1与Luminal A型乳腺癌患者化疗的疾病控制率呈明显的负相关关系,同时,PD-L1与临床疗效中疾病控制率的相关性在低水平CD_(16)^(+)CD_(56)^(+)和高水平VEGF的患者中更强。
Objective To explore the potential value of the combined detection of programmed death ligand 1(PD-L1)and vascular endothelial growth factor(VEGF)in evaluating the chemotherapeutic response of patients with luminal type A breast cancer.Methods The study included 130 patients with Luminal A type breast cancer in the First Affiliated Hospital of Henan University of Science and Technology from August 2021 to August 2024,they were divided into two groups based on immunohistochemical staining results.Kaplan-Meier curves,receiver operating characteristic(ROC)curves,analyses were used to further observe the relationship between PD-L1,VEGF,and clinical efficacy.Results The disease control rates for group 1 and group 2 were 68.24%and 86.67%,respectively.Patients positive for PD-L1 had a significantly lower disease control rate compared to those who were PD-L1 negative(P=0.022).Cox regression analysis showed that PD-L1-negative patients experienced a more pronounced improvement in disease control rates following chemotherapy[group 1 as reference;group 2 Hazard Ratio(HR),95%Confidence Interval(CI):0.98,0.97~0.99,P<0.001].After adjusting for age,course of disease,and CD3^(+)CD8^(+),multivariate Cox regression analysis indicated that elevated PD-L1 levels were associated with reduced disease control rates during chemotherapy(group 1:reference;group 2:HR,95%CI:0.98,0.98~0.99,P<0.001).Further adjustment for additional confounding factors still showed that group 2 had a lower disease control rate compared to group 1(HR,95%CI:0.49,0.36~0.67,P<0.001).Kaplan Meier curves demonstrated that positive expression of PD-L1 significantly reduced the disease control rate after chemotherapy(Log rank P=0.024).ROC curves indicated that PD-L1 had moderate predictive power for clinical efficacy,significantly better than CD3^(+)CD8^(+)and CD_(16)^(+)CD_(56)^(+),but markedly worse than VEGF(De−long test P<0.05).LOWESS curves showed that as PD-L1 levels increased,the disease control rate in clinical efficacy decreased significantly,showing a monotonically decreasing relationship.Subgroup analysis found that in patients with CD_(16)^(+)CD_(56)^(+)<16.09 and VEGF≥303.10,the negative correlation between PD-L1 and disease control rate was more pronounced.Conclusion There is a clear negative correlation between PD-L1 and the disease control rate in patients with Luminal A type breast cancer undergoing chemotherapy.Additionally,the correlation between PD-L1 and disease control rate in clinical efficacy is stronger in patients with low levels of CD_(16)^(+)CD56*and high levels of VEGF.
作者
裴雪清
郭双双
张治业
徐斌
PEI Xue-qing;GUO Shuang-shuang;ZHANG Zhi-ye;XU Bin(Second Ward,Department of Respiratory Oncology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China;Department of Breast Oncology Suegery,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China)
出处
《医药论坛杂志》
2025年第20期2136-2143,共8页
Journal of Medical Forum
基金
河南省医学科技攻关省部共建重点项目(SBGJ202102200)。
关键词
管腔A型乳腺癌
化疗
程序性死亡蛋白配体1
血管内皮生长因子
疗效
Luminal A type breast cancer
Chemotherapy
Programmed death ligand-1
Vascular endothelial growth factor
Efficacy
