梁婷　　黄慧艳　　雷先华　　李荣

[摘要] 目的 探討子宫内膜癌的微卫星不稳定性与PD-L1表达的相关性及临床意义。 方法 选取2016年1月至2018年12月在我院病理库中搜集所有行手术治疗切除子宫的内膜癌标本共120例，采用免疫组化的方法标记错配修复蛋白MLH1、MSH2、PMS2和MSH6，检测其表达水平，以（+）和（-）记录各抗体表达情况。采用免疫组化的方法标记PD-L1蛋白，以（+）和（-）记录抗体的表达情况。统计分析120例子宫内膜癌患者的微卫星状态与临床病理特征、PD-L1表达的相关性。 结果 120例子宫内膜癌患者中，MSI 40例，MSS 80例，分别占总数的33.3%、66.7%。MSI和MSS患者的年龄、体质量指数、病理分期、组织分化程度、肌层浸润深度、淋巴结转移之间比较，差异均无统计学意义（P>0.05）。MSI患者的子宫内膜癌组织、免疫及肿瘤细胞PD-L1表达阳性率分别为50.0%、42.5%，明显高于MSS患者的26.3%、17.5%，差异有统计学意义（P<0.05）。Spearman相关分析显示，子宫内膜癌的微卫星不稳定性与PD-L1表达显著相关（P<0.05）。敏感性、特异性和准确性分别为50.0%（20/40）、73.8%（59/80）、65.8%（79/120）。 结论 子宫内膜癌的微卫星不稳定性会上调子宫内膜癌组织、免疫及肿瘤细胞PD-L1表达，可以作为PD-1/PD-L1途径免疫治疗子宫内膜癌的生物标志物。

[关键词] 子宫内膜癌;微卫星不稳定性;PD-L1表达;相关性;临床意义

[中图分类号] R737.33          [文献标识码] B          [文章编号] 1673-9701（2021）11-0122-03

Correlation between microsatellite instability and PD-L1 expression in endometrial carcinoma and its clinical significance

LIANG Ting1   HUANG Huiyan2   LEI Xianhua1 LI Rong1

1.Department of Pathology，Ganzhou Cancer Hospital in Jiangxi Province， Ganzhou 341000， China; 2.Department of Pathology，the People′s Hospital of Yudu County in Jiangxi Province，Yudu 342300，China

[Abstract] Objective To investigate the correlation between microsatellite instability （MSI） and PD-L1 expression in endometrial carcinoma and its clinical significance. Methods A total of 120 cases of endometrial carcinoma specimens from the pathological database of our hospital from January 2016 to December 2018 were collected. The mismatch repair proteins MLH1， MSH2， PMS2 and MSH6 were labeled by the immunohistochemistry method，and their expression levels were detected. The expression of each antibody was recorded by（+）and（-）. The expression of PD-L1 protein was labeled by the immunohistochemistry method， and the expression of antibody was recorded by （+） and （-）. The correlation between microsatellite status （MSS） and clinicopathological features and PD-L1 expression in 120 patients with endometrial carcinoma was analyzed statistically. Results Among 120 patients with endometrial carcinoma，there were 40 cases of MSI and 80 cases of MSS， accounting for 33.3% and 66.7% of the total respectively. There were no statistically significant differences between all patients with MSI and MSS in age， body mass index，pathological stage，degree of tissue differentiation， depth of muscle infiltration and lymph node metastasis（P>0.05）. The positive rates of PD-L1 expression in endometrial carcinoma tissue，immunity and tumor cells in patients with MSI were 50.0% and 42.5%， which were significantly higher than those of 26.3%， 17.5% in patients with MSS， with significant difference（P<0.05）. It was shown by Spearman correlation analysis that MSI in endometrial carcinoma was significantly correlated with PD-L1 expression（P<0.05）. The sensitivity，specificity and accuracy were 50.0%（20/40），73.8% （59/80） and 65.8%（79/120）， respectively. Conclusion MSI in endometrial carcinoma can up-regulate the expression of PD-L1 in endometrial carcinoma tissue， immunity and tumor cells， which can be used as a biomarker of PD-1/PD-L1 immunotherapy for endometrial carcinoma.

[Key words] Endometrial carcinoma; Microsatellite instability; PD-L1 expression; Correlation; Clinical significance

子宫内膜癌是妇科常见的恶性肿瘤之一，晚期患者疗效不佳。有文献报道，存在MSI的散发性内膜癌患者预后不良[1]。部分国外学者认为[2]，MSI可作为免疫治疗反应的生物标志物，使晚期子宫内膜癌患者接受抗PD-1治疗，并从中获益。本研究统计分析了我院病理库中2016年1月至2018年12月所有行手术治疗切除子宫的内膜癌标本共120例的临床资料，旨在通过检测子宫内膜癌的MSI表型和PD-L1表达情况，并分析其相关性及表达的意义，最终探讨存在MSI的子宫内膜癌患者是否更适于接受PD-1/PD-L1抑制剂的治疗，将新的依据提供给晚期患者的个体化精准治疗，现报道如下。