發(fā)布時(shí)間：2019-01-22 13:13

【摘要】：目的:1、研究三陰乳腺癌(TNBC)中PD-L1和HIF-1α蛋白的表達(dá)及其與臨床病理參數(shù)、生存預(yù)后的相關(guān)性。探討二者共表達(dá)在TNBC中的預(yù)后價(jià)值;2、調(diào)查T(mén)NBC的中醫(yī)體質(zhì)分布特點(diǎn),分析體質(zhì)與PD-L1、HIF-1α表達(dá)及患者生存預(yù)后的相關(guān)性。方法:1、收集福州總醫(yī)院2010年1月至2013年12月手術(shù)病理確診為T(mén)NBC的患者103例,收集入組患者的臨床病理資料并隨訪其生存預(yù)后情況;2、采用免疫組織化學(xué)方法檢測(cè)PD-L1和HIF-1α的表達(dá)情況;3、運(yùn)用中華中醫(yī)藥學(xué)會(huì)的《中醫(yī)體質(zhì)分類(lèi)與判定表》對(duì)患者進(jìn)行中醫(yī)體質(zhì)辨識(shí)和分類(lèi);4、采用SPSS 20.0統(tǒng)計(jì)軟件對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1、TNBC 中 PD-L1 和 HIF-1α的陽(yáng)性率分別為 30.1%(31/103)和 54.4%(56/103),二者表達(dá)呈正相關(guān)(r=0.559,P=0.000)。PD-L1表達(dá)與腫瘤大小、淋巴結(jié)轉(zhuǎn)移、腫瘤分期顯著相關(guān)(P=0.004、0.009、0.000);HIF-1α表達(dá)與年齡、腫瘤大小、組織學(xué)分級(jí)、淋巴結(jié)轉(zhuǎn)移、腫瘤分期顯著相關(guān)(P=0.007、0.000、0.000、0.001、0.000)。Kαplαn-Meier生存曲線和Log-Rαnk分析顯示:腫瘤大小、TNM分期、淋巴結(jié)轉(zhuǎn)移情況及腫瘤PD-L1、HIF-1α表達(dá)可影響 TNBC 患者的 3 年 DFS(P=0.01、0.000、0.000、0.000、0.000),進(jìn)一步多因素分析顯示:僅腫瘤PD-L1表達(dá)與TNM分期為T(mén)NBC患者的獨(dú)立預(yù)后不良因素(P-0.016、0.002)。2、TNBC中PD-L1和HIF-1α不同的表達(dá)組合可影響患者的生存預(yù)后,共表達(dá)組即雙陽(yáng)組3年DFS率顯著低于未共表達(dá)組即單陽(yáng)組及雙陰組(P=0.000),三組生存曲線出現(xiàn)明顯分離。3、TNBC體質(zhì)由多到少依次為:氣郁質(zhì)、血瘀質(zhì)、痰濕質(zhì)、濕熱質(zhì)、氣虛質(zhì)和陰虛質(zhì)。各體質(zhì)類(lèi)型中PD-L1與HIF-1α表達(dá)無(wú)顯著差異(P=0.892、0.700),各體質(zhì)類(lèi)型3年DFS無(wú)顯著差異(P=0.655)。結(jié)論:1、PD-L1和HIF-1α在TNBC中高表達(dá),且二者表達(dá)呈正相關(guān)。PD-L1和HIF-1α表達(dá)均與不良預(yù)后相關(guān),但僅PD-L1可作為T(mén)NBC患者的獨(dú)立預(yù)后不良因素。2、PD-L1和HIF-1α共表達(dá)患者3年DFS顯著低于未共表達(dá)患者,TNBC中二者共表達(dá)提示預(yù)后不良。3、TNBC人群體質(zhì)均為偏頗體質(zhì),氣郁質(zhì)和血瘀質(zhì)所占比例最大(54.3%)。中醫(yī)體質(zhì)分類(lèi)與PD-L1/HIF-1α表達(dá)無(wú)明顯相關(guān),與TNBC患者的生存預(yù)后無(wú)明顯相關(guān)。
[Abstract]:Objective: 1. To study the expression of PD-L1 and HIF-1 偽 protein in (TNBC) and its correlation with clinicopathological parameters and survival prognosis. To explore the prognostic value of co-expression of PD-L1,HIF-1 偽 in TNBC. 2. To investigate the distribution of TCM physique of TNBC, and to analyze the correlation between constitution and PD-L1,HIF-1 偽 expression and survival prognosis of patients. Methods: 1. 103 patients with TNBC were collected from January 2010 to December 2013 in Fuzhou General Hospital. The clinicopathological data of the patients were collected and their survival and prognosis were followed up. (2) the expression of PD-L1 and HIF-1 偽 was detected by immunohistochemical method. 4. The results were analyzed by SPSS 20.0 software. Results: 1the positive rates of PD-L1 and HIF-1 偽 in TNBC were 30.1% (31 / 103) and 54.4% (56 / 103), respectively. The expression of PD-L1 was positively correlated with tumor size and lymph node metastasis. There was a significant correlation between tumor stage and tumor stage (P < 0.004 / 0. 009 / 0. 000). The expression of HIF-1 偽 was significantly correlated with age, tumor size, histological grade, lymph node metastasis and tumor stage (P0. 0070.0000.0000.0000.000). K 偽 pl 偽 n-Meier survival curve and Log-R 偽 nk analysis: tumor size, TNM stage. Lymph node metastasis and tumor PD-L1,HIF-1 偽 expression could affect the DFS of TNBC patients in 3 years. Further multivariate analysis showed that only tumor PD-L1 expression and TNM staging were independent prognostic factors (P-0.016 ~ 0.002). 2different expression combinations of PD-L1 and HIF-1 偽 in TNBC could affect the survival prognosis of TNBC patients. The 3-year DFS rate in the co-expression group (Shuangyang group) was significantly lower than that in the non-co-expression group (single positive group and double-negative group) (P0. 000). Qi deficiency and yin deficiency. There was no significant difference in the expression of PD-L1 and HIF-1 偽 between different physique types (P < 0. 892P 0. 700), but there was no significant difference in 3 years DFS expression among different physique types (P 0. 655). Conclusion: 1 the expression of PD-L1 and HIF-1 偽 in TNBC is highly expressed, and the expression of PD-L1 and HIF-1 偽 is positively correlated with the poor prognosis, but only PD-L1 can be used as an independent factor of poor prognosis in TNBC patients. The DFS in patients with PD-L1 and HIF-1 偽 co-expression in 3 years was significantly lower than that in patients without co-expression. The co-expression of TNBC and TNBC indicated that the prognosis was poor. 3. The population constitution of PD-L1 and HIF-1 偽 was biased, the proportion of qi stagnation and blood stasis was the largest (54.3%). There was no significant correlation between TCM constitution classification and PD-L1/HIF-1 偽 expression, and there was no significant correlation between TCM constitution classification and survival and prognosis of TNBC patients.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.9

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