【摘要】 目的：肺癌是全球高发恶性肿瘤，肺腺癌为非小细胞肺癌主要亚型，其诊断依赖分子标志物和临床病理特征的综合评估。程序性死亡受体配体1(programmed death-ligand 1,PD-L1)是免疫治疗核心预测指标，表皮生长因子受体(epidermal growth factor receptor,EGFR)突变是靶向治疗关键驱动变异，Ki-67反映肿瘤增殖活性。本研究旨在探讨肺腺癌患者PD-L1表达与EGFR突变、Ki-67表达及临床病理特征的相关性，为精准诊疗提供依据。方法：回顾性分析2023年12月至2024年12月在芜湖市第二人民医院就诊的109例肺腺癌患者，采用下一代测序(nextgeneration sequencing,NGS)检测EGFR突变，免疫组织化学检测PD-L1和Ki-67表达。结果：109例肺腺癌患者中，PD-L1阳性表达率为45%，其表达与肿瘤分化程度、肿瘤大小及Ki-67增殖指数均显著相关(均P<0.05)。多因素Logistic回归分析显示，分化程度和肿瘤大小为PD-L1表达的独立影响因素。EGFR突变率为65.1%，其中19号外显子缺失和21号外显子L858R突变为主要突变类型。EGFR突变多见于女性和无吸烟史患者，并与淋巴结转移和Ki-67表达相关(均P<0.05)。结论：肺腺癌中PD-L1表达水平与肿瘤大小和分化程度相关，与EGFR突变状态无明显相关性，提示肿瘤负荷可能在PD-L1调控中起关键作用。更多还原

【Abstract】 Objective: Lung cancer is one of the most prevalent malignancies worldwide, and lung adenocarcinoma is the major subtype of non-small cell lung cancer. Its diagnosis relies on the integrated assessment of molecular biomarkers and clinicopathological features. Programmed death-ligand 1(PD-L1) is a key predictive biomarker for immunotherapy, epidermal growth factor receptor(EGFR) mutations are critical driver alterations for targeted therapy, and Ki-67 reflects tumor proliferative activity. This study aims to investigate the correlation of PD-L1 expression with EGFR mutation, Ki-67 expression, and clinicopathological features in patients with lung adenocarcinoma, providing evidence for precision diagnosis and treatment.Methods: A total of 109 patients with lung adenocarcinoma treated at the Second People’s Hospital of Wuhu City from December 2023 to December 2024 were retrospectively analyzed. EGFR mutations were detected using next-generation sequencing(NGS), while PD-L1 and Ki-67 expression were assessed by immunohistochemistry.Results: Among the 109 patients, the positive expression rate of PD-L1 was 45%. PD-L1 expression was significantly associated with tumor differentiation, tumor size, and Ki-67 proliferation index(P<0.05). Multivariate Logistic regression analysis showed that tumor differentiation and tumor size were independent factors influencing PD-L1 expression. The EGFR mutation rate was 65.1%, with exon 19 deletions and exon 21 L858R mutations being the predominant mutation types. EGFR mutations were more frequently observed in female patients and those without a smoking history, and were significantly associated with lymph node metastasis and Ki-67 expression(all P<0.05).Conclusion: In lung adenocarcinoma, PD-L1 expression is associated with tumor size and differentiation but shows no significant correlation with EGFR mutation status, suggesting that tumor burden may play a key role in regulating PD-L1 expression.更多还原