| Breast cancer is one of the most common malignant tumors in women.With the development of medical technology,in order to maximize the benefits of patients,immunosuppressive therapy of breast cancer is in full swing.In this study,we analyzed the expression of programmed cell death-ligandl(PD-L1)in interstitial immune cells(ICs)of breast cancer to screen patients for immunotherapy.Part one The expression of PD-L1(Ventana SP142)in triple-negative breast cancer and its relationship with clinicopathological characteristicsObjective:This article aims to investigate the correlation between the expression of PD-L1 and the expression of tumor infiltrating lymphocytes(TILs),clinicopathological features and prognosis in triple-negative breast cancer.Methods:This study included 223 cases of TNBC.Three 2mm tumor cores were selected for each case,and the expression of PD-L1 on ICs was detected by Immunohistochemistry.Statistical software SPSS 24.00 was used for analysis,?2 test and Fisher exact test were used for correlation and consistency analysis;Logistic regression analysis was used for multivariate analysis;Kaplan-Meier analysis was used for univariate survival;Cox regression analysis was used for multivariate survival;P<0.05 was considered statistically significant.Results:1.In TNBC the expression rate of PD-L1 on ICs was 25.1%.2.In TNBC the expression of PD-L1 on ICs was significantly correlated with the histological grade and the expression of PD-L1(P<0.05);and it was an independent influencing factor of the expression of PD-L1(P<0.05).3.Univariate survival analysis of overall survival(OS)for TNBC the patient's lymph node metastasis and TILs had a significant effect on OS(P<0.05);multivariate survival analysis revealed that patients had the expression of PD-L1 on ICs as TNBC independent factors of OS(P<0.05).Part two The expression of PD-L1(Ventana SP142)in HER2-positive breast cancer and its relationship with clinicopathological characteristicsObjective:This article aims to investigate the correlation between theexpression of PD-L1 and tumor-infiltrating lymphocytes,clinicopathological features and prognosis in HER2-positive breast cancer.Methods:This study included 156 cases of HER2-positive breast cancer.Three 2mm tumor cores were selected for each case,and the expression of PD-L1 on ICs was detected by Immunohistochemistry.Statistical software SPSS 24.00 was used for analysis,?2 test and Fisher exact test were used for correlation and consistency analysis;Logistic regression analysis was used for multivariate analysis;Kaplan-Meier analysis was used for univariate survival;Cox regression analysis was used for multivariate survival;TILs and PD-L1 correlation was analyzed by Spearman rank;P<0.05 was considered statistically significant.Results:1.In HER2-positive breast cancer the expression rate of PD-L1 on ICs was 31.4%.2.In HER2-positive breast cancer the expression of PD-L1 on ICs was significantly correlated with the tumor size,the presence or absence of lymphovascular invasion,the expression of TILs,CD4 and CD8(P<0.05);obtained using Logistic multivariate regression analysis The tumor size,the presence or absence of vascular tumor plugs,the expression of TILs and CD8 were independent factors affecting PD-L1 expression(P<0.05).3.Spearman rank correlation analysis showed that TILs infiltration level was positively correlated with interstitial immune cell PD-L1 expression in HER2-positive breast cancer patients(r=0.486,P<0.05)4.Univariate survival analysis of disease-free survival(DFS)for HER2-positive breast cancer the patient's tumor size,lymphovascular invasion,lymph node metastasis,TILs,tumor immune microenvironment classification-CD4(TIME-CD4)and tumor immune microenvironment classification-CD8(TIME-CD8)has a significant effect on patients' DFS(P<0.05);multivariate survival analysis revealed that patients had lymphovascular invasion,TILs,TIME-CD4 and TIME-CD8 as HER2-positive breast cancer independent factors of DFS(P<0.05)Part three Heterogeneity of expression PD-L1(Ventana SP142)in primary and metastatic breast cancerObjective:To investigate the relationship between the expression of PD-L1 and clinicopathological parameters in primary breast cancer and matched metastatic breast cancerMethods:This study included 140 cases of primary breast cancer and their matched metastatic breast cancer cases.Among them,there were 52 cases of lymph node metastasis,88 cases of distant metastasis.The expression of PD-L1 on ICs was detected by Immunohistochemistry.Statistical software SPSS 24.00 was used for analysis and processing.x2 test and Fisher exact test,Mc Nemar test,and Kappa test were used for correlation and consistency analysis.Multivariate analysis was performed using Logistic regression analysis,P<0.05 was considered statistically significantResults:1.In 140 cases of breast cancer and matched metastatic breast cancer the expression rates of PD-L1 on ICs were 40.7%and 42.1%2.The overall change rate of the expression rates of PD-L1 on ICs in primary and matched metastatic breast cancer was 27.1%,there was no significant difference(P=0.871);the overall consistency rate was 72.9%(k=0.441),the general consistency was general.The expression rate of PD-L1 were 25.0%and 28.4%in primary and matched lymph node metastasis and distant metastasis,respectively.The difference was not statistically significant(P=0.267,P=0.230),the consistent rate was 75.0%(k=0.472),71.6%(k=0.426),the consistent rate was general.The expression rate of PD-L1 in interstitial immune cells of breast cancer between primary and matched lung metastasis was 28.6%,the difference was statistically significant Meaning(P=0.031).3.The expression of PD-L1 on ICs of primary breast cancer was significantly correlated with tumor size,histological grade,lymphovascular invasion,lymph node metastasis,and Ki67 index(P<0.05),Logistic multivariate regression analysis was used to determine whether lymph node metastasis was an independent influencing factor for PD-L1 expression(P<0.05);the expression of PD-L1 in metastatic breast cancer interstitial immune cells was significantly correlated with the expression of ER(P<0.05).4.The overall variability of the expression of ER,PR,and Ki67 in primary and matched metastatic breast cancer were 18.5%,30.7%,and 21.4%,the difference was statistically significant(P=0.000,P=0.014,P=0.016).The overall change rate of HER2 expression was 7.1%,the difference was not statistically significant(P=0.344),the overall agreement rate was 92.9%(k=0.834),and the agreement between the two was good.Conclusions:1.The expression of PD-L1 on ICs in TNBC is related to the histological grade of the patient and TILs.2.The independent influencing factor of overall survival in patients with TNBC is the expression of PD-L1 on ICs.The patients with PD-L1 positive expression have a poor prognosis.3.The expression of PD-L1 on ICs in HER2-positive breast cancer is related to tumor size,presence or absence of lymphovascular invasion,TILs,CD4 expression and CD8 expression.4.The independent influencing factors of disease-free survival in patients with HER2-positive breast cancer are the presence or absence of lymphovascular invasion,TILs,TIME-CD4 and TIME-CD8.Among them,patients with no lymphovascular invasion and higher levels of tumor infiltrating lymphocytes had better prognosis;CD4-/PD-L1-group had better prognosis in the TIME-CD4 and CD8+/PD-L1-group had better prognosis in the TIME-CD8.5.There is a positive correlation between TILs infiltration level and PD-L1 expression,suggesting that HER2-positive breast cancer patients can be accurately treated according to different TILs infiltration levels and PD-L1 expression.6.The expression of PD-L1 is consistent between primary matched metastatic breast cancer,and it is different from that of paired lung metastases.The expression of PD-L1 in distantly transferred biopsies needs to be re-evaluated to optimize the clinical applicability of PD-L1. |
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