PD-L1检测对于膀胱尿路上皮癌灌注卡介苗疗效的预测价值
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v7i5.16514
Abstract
目的：卡介苗(BCG)灌注是治疗膀胱尿路上皮癌(BUC)的重要免疫治疗方法,但患者对BCG治疗的反应存在显著差异。本研究旨在探讨PD-L1检测对膀胱尿路上皮癌患者接受BCG灌注治疗疗效的预测价值。方法：研究纳入2022年8月至2024年9月期间101例接受BCG灌注治疗后行二次电切或根治性膀胱切除术的尿路上皮癌患者,依据BCG治疗效果分为病理缓解组(CR)和病理未缓解组(non-CR)。通过免疫组化检测手术切除标本中PD-L1的表达水平,并分析其与患者临床病理特征、治疗反应及预后的关系。结果：PD-L1在病理未缓解组中的表达显著高于病理缓解组(P<0.05),表明PD-L1表达与BCG治疗效果密切相关。进一步分析发现,PD-L1阳性表达患者的复发风险显著升高(P<0.05),且在多因素COX回归分析中,PD-L1阳性表达仍为独立危险因素(HR=4.264,P<0.05)。此外,PD-L1表达与肿瘤标志物CA19-9水平显著相关(P=0.004),并与免疫指标CD3、P53表达存在显著相关性(P=0.017,P=0.008)。结论：PD-L1检测可作为评估BCG治疗反应的潜在生物标志物,为膀胱尿路上皮癌的个体化治疗方案优化提供理论依据和实践指导。对于PD-L1高表达患者,尤其是BCG治疗反应不佳的患者,建议尽早切换治疗方案以改善预后,并将治疗后PD-L1检测纳入动态管理模式以优化治疗效果。
Keywords
膀胱尿路上皮癌；卡介苗灌注治疗；程序性死亡受体配体1；复发；免疫组化
Funding
内蒙古自治区自然科学基金(2022QN08021)。
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