| Part 1:The correlation between the expression of PD-L1 and infiltrated immune cells and clinicopathological characteristics and patientsprognosis in gastric cancerObjective:to detect the expression of PD-L1,CD3,CD4,CD8,CD19,CD11c,CD31,CD56,CD68,?-SMA,Foxp3 in 268 surgical specimens in patients with gastric cancer respectively,to analyze their correlation with the clinicopathologic features of patients.At the same time,the relationship between the expression of PD-L1 and tumor infiltrated immune cells and patients survival was also analyzed.Methods:we collect 268 cases of gastric adenocarcinoma which were surgically resected and diagnosed by pathology physician,the tissue microarray was made,using the method of immunohistochemical staining to detect the expression level of PD-L1 and immune cells in tumor tissues.we analyzed the correlation between these indexes and clinical pathological parameters of patients through Chi-Square inspection.The Kaplan-Meier curve was used to analyze patients' survival.The relationship between the expression of PD-L1 or tumor infiltrated immune cells and clinicopathological features and prognosis were analyzed by univariate and multivariate COX regression survival analysis,The difference was statistically significant(P<0.05).Results:PD-L1 was expressed in tumor cells and tumor immune cells,PD-L1 highly expressed in tumor cells was 19.40%(52/268),while there was totally 62.31%(167/268)highly expressed in tumor immune cells.Through Kaplan-Meier analysis,we found only iPD-L1 had the correlation with patients' survival time(P=0.028);Kaplan-Meier analysis suggested there was no statistically significant no matter expressed rich or lower of CD3 and CD4(P=0.076,P=0.089);The higher expression of CD8 or CD 19,the longer survival time patients would have,and the difference was statistically significant(P=0.020,P=0.001).The other indexes such as CD 11c,CD31,CD56,CD68,a-SMA and Foxp3 were not related to the patients' survival no matter high or low expression.Univariate COX regression indicated that tumor stage,tumor depth,lymph node involvement,metastasis,low expression of CD8,CD 19 and iPD-L1 were the adverse factors affecting patients prognosis,and multivariate COX regression survival analysis showed that tumor stage,lymph node involvement and CD8 expression were independent factors affecting patients survival.Conclusion:PD-L1 expressed in tumor cells and tumor immune cells,but mainly expressed in tumor immune cells.The expression of IPD-L1,the infiltrated CD8,CD 19 in tumor tissue were related to patients' survival,in other words,the higher expression of them,the better outcome of patients would have;The other indexes were not correlated with the survival of patients.In Gastric cancer,tumor stage,lymph node involvement and CD8 expression were associated with the prognosis of patients,it was suggested that they can be used as independent factors to affect patients survival.Part 2:The relationship between the expression of PD-L1 and tumor infiltrated immune cells and conjoint analysis to forecast patients prognosisObjective:To investigate the relationship between the expression of PD-L1 and the immune cells infiltrated in tumor tissue,and forecast the patients prognosis by conjoint application.Methods:The same as the first part,268 cases gastric cancer were collected,tissue microarray was made,to analyze the correlation between PD-L1 expressed in tumor cells or tumor immune cells and CD3,CD4,CD8,CD19,CDllc,CD31,CD56,CD68,a-SMA and Foxp3 by the means of immunohistochemical staining.The effect of conj oint expression on the prognosis of patients was analyzed statistically.Results:We found that PD-L1 was positively correlated with the expression of CD3,CD8,CD31 and CD68 no matter it expressed in tumor cells or tumor immune cells.Patient subgroup with PD-L1highCD3high was associated with longer OS when compared with the subgroup with PD-L1lowCD3low.The similar results can also be observed in the subgroup of PD-L1/CD8.And in the subgroup of PD-L1/CD31,we found that patients with PD-LlhighCD31low had the better prognosis than PD-LllowCD31high.It was worth noting that patients with iPD-L1highCD68low had the longer survival time when compared with patients with iPD-L1lowCD68high,the difference had obvious statistical significance(P=0.005),but in the subgroup of TPD-L1/CD68,we didn't find any valuable clinical significance(P=0.344).In addition,when combined PD-L1 with CD4,CD 19,CD11c,CD56,a-SMA,FOXP3 separately,no statistically significant was found in the patients prognosis(P>0.05).Conclusion:No matter PD-L1 expressed in tumor cells or tumor immune cells,it was positively correlated with the expression of CD3,CD8,CD31 and CD68.And PD-LlhighCD3high or PD-LlhighCD8high can be used as the combination to forecast patients good prognosis.Moreover,patients with PD-L1lowCD31high or iPD-L1lowCD68high had the poor outcome,which can provide comprehensive information for assess patient's prognosis. |
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