Study On The Correlation Between PD-L1 Expression And Survival In Lung Cancer Pleural Effusion

Objective To observe the expression of PD-L1 protein in lung cancer pleural effusion and to evaluate the clinical application value of PD-L1 expression in cell block and survival of patients and cell block PD-L1.Methods To collect the patients with thoracoscopy of thoracic cavity in the respiratory department of the central hospital of dalian city from January 2014 to November 2016.All patients were preoperative or intraoperative drainage of 200ml pleural effusion to make cell block for pathological examination.Pleural tissue pathology and cell block pathology were selected for lung adenocarcinoma patients,and the expression of PD-L1 was detected by immunohistochemical method,and the differences between PD-L1 expression in the two specimens were compared.The clinical TNM staging and survival time of patients with lung cancer were recorded,and the correlation between the expression and survival of PD-L1 in pleural effusion was evaluated.Results1.The cell block of PD-L1 protein expression positive rate:in the two groups of specimens,respectively by 1?3?5 minute is divided into PD-L1 positive Cutoff value,order of cell blocks and PD-L1 positive rate is 64.7%(11/17),41.1%(7/17),23.5%(4/17),the order of the pleura and positive rate is 64.7%(11/17),35.2%(6/17),11.7%(2/17);When comparing different Cutoff values,the cell block was different from the positive detection rate of the pleural membrane,1 point(Kappa=0.227,P=0.349),3(Kappa=-0.191,P=0.349)and 5 points(Kappa=0.605,P=0.007).The positive detection rate of the two specimens was the same when 1 and 3 were divided into Cutoff values,and P<0.05 was not statistically significant.The cell block detection rate was better than that of the pleural tissue(23.5%vs 11.7%),and the difference was statistically significant,and the Kappa value=0.605.2.Pleural effusion cells block with pleural tissue pathology of PD-L1immunohistochemical conformity assessment:adopt the method of organized dye to test the biopsy in PD-L1,comparing the differences of two specimens of PD-L1expression.The Wilcoxon signed rank sum test was the rank sum 33,negative rank and28,and the z-value of the test results was-1.389,P value was 0.165,and the immunohistochemical results of the two groups were not statistically significant(P>0.05).3.Cell morphology:the cells were collected with sufficient number of cells,uniform distribution,no cell accumulation and overlapping phenomena,and the morphology was similar to that of tissue sections.The cell block group PD-L1 was accurate in the coloration of tumor cells,and the background was clear,which was more conducive to observation.Thoracic water cell block was equal to pleural pathology in the detection accuracy of PD-L1,and was superior to pleural tissue in the observation of tumor cell morphology.4.Pleural effusion cells block and pleural tissues PD-L1 the influence of protein expression of animal survival:collected 17 cases accord with standard of patients with lung adenocarcinoma,elimination of 7 patients with untreated confounding effects,the remaining ten patients.1 point as Cutoff value,6 cases of PD-L1 in the cell block group,and the median survival time of 26.00 months,and 4 cases of PD-L1,the median survival time was 23.00 months,X~2=0.448,P=0.503,both of which had no statistical significance;3 point as Cutoff value,4 cases of pd-l1 in the cell block group,median survival time was 27.00 months,PD-L1 negative 6 cases,median survival time was26.00 months,X~2=0.167,P=0.683,both of which had no statistical significance;5 point as Cutoff value,2 cases of PD-L1 in the cell block group,and the median survival time was 12.00 months,and 8 cases of PD-L1 were negative.The median survival time was27.00 months,X~2=7.000,P=0.008,and the difference was statistically significant.In the case of Cutoff value of 5,the median survival time of the PD-L1 negative group was significantly longer than that in the PD-L1 positive group,while the survival period of PD-L1 was shorter and the prognosis was worse.5.The relationship between the expression of PD-L1 protein and clinical case data:the Cutoff value of PD-L1 expression positive was divided into 5 point.There was no correlation between the PD-L1 expression and the gender,age,and smoking of the pleural tissue in the pleural tissues.The results of the two groups were consistent(P>0.05).ConclusionThe breast water cell block can be used for the clinical detection of PD-L1.In the case of cutoff value 5,the expression of PD-L1 in patients with lung adenocarcinoma patients was indicated with poor prognosis.