| Objective: In recent years,immune-checkpoint inhibitors(mainly antiPD-1/PD-L1 antibodies)has made great progress,from the second-line therapy of advanced non-small cell lung cancer becoming a first-line treatment for high expression of PD-L1.The expression of PD-L1 has become a predictive marker for the efficacy of immunotherapy.The expression was analyzed by immunohistochemical method to detect PD-L1 and PD-1 in patients with lung cancer,exploring the relationship between expression of PD-L1 and biological characteristics of patients(gender,age,smoking status,clinical stage,histological type,NapsinA,Ki67,EGFR,ALK,C-Met,KRAS).Analyse and explore the efficacy of Durvalumab as first-line treatment.Methods: Collection lung cancer patients from the Fourth Hospital of Hebei Medical University during January 2017 to January 2018,filtrating them according to the inclusion and exclusion criteria that confirmed by histology or cytology.All specimens were tested with PD-L1 and PD-1 status and have assessment of lesions in imaging(CT/ MRI).Collection the clinical information and characteristics of patients(Sex,age,smoking,clinical stage,histology type,Ki67 expression,NapsinA expression,EGFR gene mutation,ALK fusion,C-Met)and the relationship with positive expression of PD-L1.Results: There are 66 patients collected in this study,with an average age of 60.5 ± 5.13 years,80.3% of males and 69.7% of smokers.Patients in phase IV accounted for 59.1%.The positive rate of PD-L1 expression was 45.5%,and the positive rate of PD-1 positive expression was 0.The PD-L1≥10%,≥20%,≥ 50% were 76.7%,60%,36.7%,respectively.Analyse the relationship between the expression of PD-L1 and the clinical features.The positive rates of PD-L1 in smoking and non smoking patients was39% and 60%(P > 0.05),in men and women was 43% and 54%(P > 0.05),60 years of age or older and younger than 60 years old t was 49% and 39%(P >0.05),in phase II-III and IV was 37% and 51%(P > 0.05),which between initial treatment and second or multiline treatment was 45.8% and 42.9%(P >0.05).The rates of EGFR(+)and EGFR(-)with PD-L1 positive expression was58% and 43%,respectively(P > 0.05).The rates of C-Met(+)and C-Met(-)with PD-L1 positive expression was 48% and 20%(P > 0.05).The rates of Ki67 ≥ 50% and Ki67 < 50% with PD-L1 positive expression was 50% and58%(P > 0.05).The rates of TTF-1(+)and TTF-1(-)with PD-L1 positive expression was 61.5% and 45.5%(P > 0.05).By comparing the relationship between NapsinA and PD-L1,the rates of Napsin A(+)and NapsinA(-)with PD-L1 positive expression was 71.4%(15/21)and 36.4%(8/22),Spearman correlation analysis P=0.021,correlation coefficient rs=0.351,there is a positive correlation between them.It shows that the positive rate of PD-L1 expression in NapsinA expression positive people is higher.From analysing the relationship between the type of lung cancer and the expression of PD-L1,the positive rate of PD-L1 expression in adenocarcinoma was higher than that in squamous cell carcinoma(57% vs.38.5%),but the difference was not statistically significant(P=0.149).Two cases were treated with Durvalumab by evaluation of treatment after two cycles that one was stable,the other was partially relieved.Conclusions:1.The positive rate of PD-L1 expression in the patients with lung cancer was 45.5%,and the positive rate of PD-1 expression was 0.The PD-L1 is more than 10%,more than 20%,more than 50% were 76.7%,60%,36.7%,respectively.2.The positive rate of PD-L1 expression in NapsinA positive lung cancer patients was significantly higher than that of NapsinA negative ones.3.There was no difference in the expression of PD-L1 in lung adenocarcinoma compared to the squamous cell carcinoma of the lung.4.The positive rate of PD-L1 expression was not related to smokingstatus,sex,age,clinical stage,EGFR mutation status,ALK fusion,C-Met expression,Ki67 expression and TTF-1 expression.5.The high expression of PD-L1(≥50%)in 2 cases of the patients with non-small cell lung cancer using Durvalumab showed good clinical benefit. |
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