【摘要】 目的探讨共刺激分子B7-H4和程序性死亡受体配体1(PD-L1)的表达对中高危非肌层浸润性膀胱癌(NMIBC)膀胱灌注后复发的影响。方法将126例经尿道膀胱肿瘤电切术后病理证实为中高危的NMIBC患者按术后膀胱灌注化疗药物的不同分为吉西他滨组85例及卡介苗组41例,检测所有膀胱癌组织中B7-H4和PD-L1的表达情况,并统计分析B7-H4和PD-L1的表达对膀胱肿瘤术后不同灌注药物复发的影响。结果 126例中高危NMIBC中,B7-H4阳性表达率为53.2%(67/126),PD-L1阳性表达率为57.9%(73/126),B7-H4和PD-L1联合表达阳性率为38.1%(48/126),联合表达阴性率为27.0%(34/126)。中高危NMIBC患者总复发率为37.3%(47/126),卡介苗组患者复发率为24.4%(10/41),低于吉西他滨组的43.5%(37/85),差异有统计学意义(P﹤0.05)。联合表达B7-H4和PD-L1的患者中,术后灌注吉西他滨患者的复发率为18.2%,低于卡介苗组的53.3%;均未表达B7-H4和PD-L1的患者中,术后灌注吉西他滨患者的复发率为60.9%,高于卡介苗组的18.2%,差异均有统计学意义(P﹤0.05)。结论根据B7-H4和PD-L1的表达情况选择卡介苗或化疗药物膀胱灌注,能降低中高危NMIBC电切术后的复发率,改善预后。更多还原

【Abstract】 Objective To investigate the effect of the expression of co-stimulatory molecules B7-H4 and programmed cell death 1 ligand 1(PD-L1) on the recurrence of moderate-to high-risk non-muscle invasive bladder cancer(NMIBC) after intravesical perfusion. Method A retrospective study of 126 patients with moderate-to high-risk NMIBC confirmed by postoperative pathology after transurethral resection of bladder tumor was performed. These patients were treated with intravesical chemotherapy of gemcitabine(gemcitabine group, n=85) or bacillus calmette-guérin(BCG group, n=41), the B7-H4 and PD-L1 expression in all bladder cancer tissues were detected, furthermore, the effects of B7-H4 and PD-L1 expression on the recurrence after intravesical perfusion with different medications were statistically analyzed. Result Of the 126 cases with moderate-to high-risk NMIBC, the positive expression rate of B7-H4 was53.2%(67/126), the positive expression rate of PD-L1 was 57.9%(73/126), and combined positive expression rate of B7-H4 and PD-L1 was 38.1%(48/126), corresponding to a combined negative expression rate of 27.0%(34/126). In moderate-to high-risk NMIBC patients, the overall recurrence rate was 37.3%(47/126), and it was 24.4%(10/41) in BCG group, lower than the 43.5%(37/85) in gemcitabine group, and the differences were statistically significant(P<0.05).Among patients with combined expression of B7-H4 and PD-L1, the recurrence rate after postoperative intravesical perfusion of gemcitabine was 18.2%, which was lower compared to the 53.3% in BCG group; in patients with neither B7-H4 nor PD-L1 expression, the recurrence rate observed after postoperative intravesical perfusion of gemcitabine was 60.9%,and was higher versus the 18.2% noted in BCG group, showing statistically significant difference(P<0.05). Conclusion According to the expression of B7-H4 and PD-L1, the medications for intravesical perfusion could be selected correspondingly, thereby reducing the recurrence rate and improving the prognosis of patients with moderate-to high-risk nonmuscle invasive bladder cancer.更多还原