The Clinical Significance Of PD-L1/HIF-1? Expression In Triple Negative Breast Cancer And Its Relationship With TCM Constitutional Types

Object:1.To evaluate the expression of PD-L1 and HIF-la in triple negative breast cancer(TNBC)and to investigate the correlation between PD-L1/HIF-la expression and clinicopathologic features and prognosis.To observe the clinical value of their co-expression.2.To investigate the TCM constitution of TNBC patients and try to understand if there is any correlation between TCM constitution and PD-Ll/HIF-1? expression.Methods:1.A total of 103 eligible patients who were diagnosed with TNBC by pathology,were enrolled.The medical records of patients were collected and their survival were followed up.2.Paraffin-embedded tumor sections were stained with PD-L1/HIF-1?antibody.3.To identify the TCM constitutional types of patients with the "Chinese medicine constitution and judgment table" formulated by Chinese Society of Chinese Medicine.4.The SPSS 20.0 was used for all analyses.Results:1.The positive rates of PD-L1 and HIF-1? expression were 30.1%(31/103)and 54.4%(56/103),respectively.High PD-L1 expression was significantly correlated with that of HIF-1?(r=0.5595,P=0.000).High expression of PD-L1 was correlated with larger tumor size,more positive lymph node number and advanced stage(P=0.004?0.009?0.000),HIF-1?expression was also associated with these characteristics,in addition,the expression of HIF-1?was also related to age and tumor grade(P=0.007?0.000?0.000?0.001?0.000).Survival analysis using a Kaplane-Meier survival plot with log-rank test identified five significant risk factors for poor 3-year disease-free survival(DFS)(P=0.01?0.000?0.000?0.000?0.000):larger tumor size,advanced stage,lymph node invasion,positive PD-L1 expression and HIF-la expression.In multivariate analysis,advanced stage and positive PD-L1 expression were significantly associated with poor 3-year DFS(P=0.016?0.002).2.There was significant difference among different forms of PD-L1/HIF-la co-expression.Patients with both high PD-L1 and HIF-la expression had worse 3-year DFS compared with those with no PD-L1 and HIF-1?co-expression(P=0.000),Kaplane-Meier survival plot was clearly separated.3.The TCM constitutional types of patients with TNBC were sorted from more to less:Qi stagnancy type?blood stasis type?phlegm wet calculus type?damp-heat type?Qi deficiency type and Yin deficiency type.There was no significant difference in PD-L1 and HIF-1? expression among various TCM types(P=0.892?0.700),and there was no significant difference in 3-year DFS rate among various TCM types(P=0.655).Conclusion:1.PD-L1 and HIF-1? are over-expressed in TNBC,and there is a positive correlation between the two proteins.Either PD-L1 or HIF-1? expression is associated with poor survival,but only PD-L1 expression is an independent negative prognostic factor in TNBC.2.Patients with both high PD-L1 and HIF-1? expression had worse 3-year DFS compared with those with no PD-L1 and HIF-1? co-expression,indicating that the co-expression of PD-L1 and HIF-1? is related to poor prognosis.3.All of patients enrolled in this study were biased constitutional types,of which Qi stagnancy constitution and blood stasis constitution took the majority(54.3%).There is no relationship between TCM constitutional types and PD-L1/HIF-1? expression,there is no correlation between TCM constitutional types and the clinical prognosis of patients with TNBC.