尿路上皮癌PD-L1、AR及P53表达及其与临床预后相关性

doi:10.16150/j.1671-2870.2025.03.007

摘要/Abstract

摘要：

目的：观察尿路上皮癌（urothelial carcinoma, UC）患者肿瘤组织中程序性死亡受体配体1(programmed cell death 1 ligand 1, PD-L1)、P53、雄激素受体（androgen receptor，AR）表达，统计其与患者预后间的相关性。方法：回顾性收集2017年5月至2020年2月东部战区总医院及鼓楼医院连续收治的、病例资料完整的115例UC患者，采用免疫组织化学（免疫组化）法检测病理组织中PD-L1、P53、AR蛋白的表达。运用卡方检验（χ²检验）分析上述标志物与临床病理特征间的相关性；Kaplan-Meier生存曲线函数分析标志物与预后间的相关性。结果：本研究病例中位随访时间为32.5个月（1~54个月），疾病进展22例，死亡17例（17.2%）。UC组织中PD-L1、P53、AR的表达率分别为46.1%、45.2%、7.8%。PD-L1阳性表达与临床进展期相关（阳性组54.9%比阴性组31.8%，P=0.016），AR阳性病例肿瘤易呈多灶性生长（21.7%比4.3%，P=0.019）。P53的表达与UC的临床病例特征均无相关性。PD-L1、P53、AR在尿路上皮癌的阳性表达率均与患者的总生存期无关。结论：PD-L1阳性表达与UC与疾病进展相关。PD-L1、P53及AR表达与UC患者的短期生存预后无关，其中AR达率低，且与短期预后无相关性，提示UC患者进行AR靶向治疗有一定的局限性。

关键词: 尿路上皮癌, 临床病理, 程序性死亡受体配体1, 雄激素受体, 预后

Abstract:

Objective This study aims to observe the expression of programmed cell death 1 ligand 1 (PD-L1), P53, and androgen receptor (AR) in tumor tissues of patients with urothelial carcinoma (UC) and analyze their correlation with patient prognosis. Methods A retrospective analysis was conducted on 115 UC patients with complete clinical data who were admitted consecutively to the General Hospital of Eastern Theater Command and Nanjing Drum Tower Hospital from May 2017 to February 2020. Immunohistochemistry was used to detect the expression of PD-L1, P53, and AR proteins in pathological tissues. The chi-square test (χ² test) was employed to analyze the correlation between these biomarkers and clinicopathological characteristics. Kaplan-Meier survival analysis was used to evaluate the relationship between biomarker expression and prognosis. Results The median follow-up time for the study cohort was 32.5 months (range: 1-54 months). Disease progression occurred in 22 cases, and 17 patients (17.2%) died. The expression rates of PD-L1, P53, and AR in UC tissues were 46.1%, 45.2%, and 7.8%, respectively. Positive PD-L1 expression was associated with clinical progression (54.9% in the positive group vs. 31.8% in the negative group, P=0.016). AR-positive cases were more likely to exhibit multifocal tumor growth (21.7% vs. 4.3%, P=0.019). P53 expression showed no significant correlation with the clinical characteristics of UC. The positive expression of PD-L1, P53, and AR was not associated with overall survival in UC patients. Conclusion Positive PD-L1 expression is associated with disease progression in UC. The expression of PD-L1, P53, and AR is not correlated with short-term survival prognosis in UC patients. Among them, AR expression rate is low and shows no association with short-term prognosis, suggesting that AR-targeted therapy for UC patients has certain limitations.

Key words: Urothelial carcinoma, Clinicopathology, Programmed cell death 1 ligand 1, Androgen receptor, Prognosis

中图分类号:

R737.15
R449

周晓蝶, 戚荣鑫, 王璇, 余波, 王建军, 石群立, 饶秋, 鲍炜. 尿路上皮癌PD-L1、AR及P53表达及其与临床预后相关性[J]. 诊断学理论与实践, 2025, 24(03): 286-292.

ZHOU Xiaodie, Qi Rongxin, WANG Xuan, YU Bo, WANG Jianjun, SHI Qunli, RAO Qiu, BAO Wei. Expression of PD-L1, AR, and P53 in urothelial carcinoma and their correlation with clinical prognosis[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(03): 286-292.

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参考文献 20

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Patient charateristics	PD-L1	P53	AR	Ki-67（≥30%）
Positive cases	53（46.1）	52（45.2）	9（7.8）	63（54.8）
Gender
Male	45（46.4）	48（44.4）	7（7.2）	53（54.6）
Female	8（44.4）	4（45.4）	2（11.1）	10（55.6）
Neural invasion
No	36（41.9）	36（41.9）	6（7.0）	47（54.7）
Yes	17（58.6）	16（55.2）	3（10.3）	16（55.2）
Vascular invasion
No	30（41.7）	31（43.1）	4（5.6）	33（45.8）
Yes	23（53.5）	21（48.8）	5（11.6）	30（69.8）^*
AJCC clinical staging
Ⅰ/Ⅱ	14（31.8）	15（34.1）	3（6.8）	20（45.5）
Ⅲ/Ⅳ	39（54.9）^＊	37（52.1）	6（8.5）	43（60.6）
Primary site
UB	66（82.5）	39（48.8）	8（10.0）	29（36.3）
Upper tract	30（85.7）	18（51.4）	1（0.9）	13（37.1）
Single/multifocal
Single	43（46.7）	41（44.6）	4（4.3）	48（52.2）
Multifocal	10（43.5）	11（47.8）	5（21.7）^＊	15（65.2）
With carcinoma in situ
Without	44（46.3）	42（44.2）	5（5.3）	50（52.6）
With	9（45.0）	10（50.0）	4（20.0）	13（65.0）
UC subtype, n(%)
Low-grade	1（20.0）	2（40.0）	0（0.0）	0（0.0）
High-grade	33（48.5）	26（38.2）	5（7.4）	36（52.9）
Histological type	19（45.2）	24（57.1）	4（9.5）	27（64.3）
Lymph node metastasis
No	25（41.0）	36（41.0）	3（4.9）	35（57.4）
Yes	17（63.0）	16（59.3）	2（7.4）	19（70.4）