本文關(guān)鍵詞： 人乳頭瘤病毒 頭頸部鱗狀細(xì)胞癌 PD-L1 P16　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:近年來,已經(jīng)證實(shí)人乳頭瘤病毒感染(Human papillomavirus,HPV)與頭頸部鱗狀細(xì)胞癌(head and neck squamous cell carcinomas,HNSCC)密切相關(guān),P16蛋白狀態(tài)和人乳頭瘤病毒的感染狀態(tài)具有較好的一致性,即P16蛋白是HPV穩(wěn)定可靠的替代指標(biāo).頭頸部鱗狀細(xì)胞癌,已被認(rèn)為是一種免疫抑制性疾病,其存在高度的免疫抑制。腫瘤細(xì)胞表面的程序性死亡分子的配體(Programmed death ligand-1,PD-L1)的表達(dá)被認(rèn)為是其潛在的發(fā)病機(jī)制,本文通過檢測PD-L1和P16在口咽及口腔鱗狀細(xì)胞癌中的表達(dá),分析其與臨床病理特征及預(yù)后之間的聯(lián)系,探討PD-L1與P16在口咽及口腔鱗狀細(xì)胞癌患者中的臨床意義。方法:收集大連醫(yī)科大學(xué)附屬第二醫(yī)院于2012年2月至2016年3月收治的口咽及口腔鱗狀細(xì)胞癌患者39例,全部進(jìn)行手術(shù)并有病理證實(shí);通過免疫組化方法檢測P16和PD-L1在組織切片中的表達(dá)情況,統(tǒng)計(jì)分析二者之間的相關(guān)性及其與患者年齡、吸煙史、飲酒史、分期、淋巴結(jié)轉(zhuǎn)移情況等臨床病理特征之間的關(guān)系,并對(duì)影響口咽及口腔鱗狀細(xì)胞癌患者的PFS影響因素進(jìn)行分析。結(jié)果:在39例口咽及口腔鱗狀細(xì)胞癌的患者中,74.4%的患者PD-L1呈陽性表達(dá),25.6%患者呈陰性表達(dá)。其中弱陽性表達(dá)有12例,占30.8%,陽性表達(dá)有5例,占12.8%,強(qiáng)陽性表達(dá)有12例,占30.8%。59.0%的患者P16呈陽性表達(dá),41.0%為陰性表達(dá)。在23例P16表達(dá)陽性的患者中,21例表達(dá)PD-L1,占91.3%,在16例P16陰性的患者中8例表達(dá)PD-L1,占50%,兩組之間具有統(tǒng)計(jì)學(xué)意義(P?0.05)。PD-L1的表達(dá)與淋巴結(jié)轉(zhuǎn)移情況顯著相關(guān)(P=0.001),與患者的年齡、性別、吸煙、飲酒、T分期、AJCC分期、分化程度、原發(fā)腫瘤部位、治療方案均無統(tǒng)計(jì)學(xué)差異(P＞0.05)。P16的表達(dá)與患者的淋巴結(jié)轉(zhuǎn)移情況存在相關(guān)性(P=0.032),而與患者的年齡、性別、吸煙、飲酒、T分期、N分期、AJCC分期、分化程度、原發(fā)腫瘤部位、治療方案均無統(tǒng)計(jì)學(xué)差異(P＞0.05)。通過分析39例患者的中位PFS為23.17個(gè)月,得出PD-L1陽性的患者中位PFS為23.38個(gè)月,陰性的患者為19.75個(gè)月,差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。PD-L1與P16均為陽性患者的中位PFS為23.20個(gè)月,PD-L1陽性P16陰性的患者中位PFS為17.00個(gè)月,PD-L1陰性P16陽性的患者的中位PFS為40.00個(gè)月,PD-L1與P16均為陰性的患者中位PFS為19.33個(gè)月,差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。結(jié)論:1、PD-L1在口咽及口腔鱗狀細(xì)胞癌高度表達(dá),與P16的表達(dá)及淋巴結(jié)轉(zhuǎn)移情況相關(guān),與患者的PFS未證實(shí)相關(guān)性。2、P16在口咽及口腔鱗狀細(xì)胞癌高度表達(dá),與PD-L1的表達(dá)及淋巴結(jié)轉(zhuǎn)移情況相關(guān),與患者的PFS未證實(shí)存在相關(guān)性。3、PD-L1在口咽及口腔鱗狀細(xì)胞癌中的表達(dá)與HPV感染相關(guān),HPV陽性的患者中PD-L1表達(dá)顯著高于HPV陰性的患者。4、PD-L1與P16在口咽及口腔鱗狀細(xì)胞癌中的共表達(dá)與預(yù)后未證實(shí)相關(guān)性,但P16陽性PD-L1陰性的患者預(yù)后最好。
[Abstract]:Objective: in recent years, has confirmed that the human papilloma virus infection (Human papillomavirus HPV) head and neck squamous cell carcinoma (head and neck squamous cell carcinomas, HNSCC) is closely related to the infection state of P16 protein and human papilloma virus have good consistency, the P16 protein is a stable and reliable alternative index HPV. Head and neck squamous cell carcinoma, has been considered as a disease of immune suppression, the height of immunosuppression. Tumor cell surface ligand programmed death molecule (Programmed death ligand-1, PD-L1) expression is thought to be the underlying mechanism, through the detection of PD-L1 and P16 expression in oral and oropharyngeal squamous cell carcinoma, analyze its relationship with clinicopathological features and prognosis, to investigate the clinical significance of PD-L1 and P16 in patients with oropharyngeal and oral squamous cell carcinoma. Methods: the collection of Dalian Medical University 39 patients with oral squamous cell carcinoma of the oropharynx and Second Affiliated Hospital from February 2012 to March 2016 were all cases, surgery and pathology; expression by immunohistochemical method to detect P16 and PD-L1 in tissue sections, statistical analysis between the two and their correlation with patient age, smoking history, drinking history, staging the relationship between clinicopathological characteristics and lymph node metastasis, and the influencing factors of PFS effect of oropharynx and oral squamous cell carcinoma patients were analyzed. Results: in 39 cases of oral and oropharyngeal squamous cell carcinoma patients, 74.4% patients with PD-L1 positive expression, negative expression in 25.6% patients. Among them there are weak positive expression in 12 cases, accounting for 30.8%, the positive expression in 5 cases, accounting for 12.8%, a strong positive expression in 12 cases, accounting for 30.8%.59.0% of the patients with P16 positive expression and negative expression in 41%. In 23 cases of patients with P16 positive expression in 21. 渚嬭〃杈綪D-L1,鍗，

本文編號(hào)：1469642