Investigate The Clinical Value Of PD-L1/mTOR Expression In Triple Negative Breast Cancer Patients And Their Correlation With TCM Constitution Types

Objective:A retrospective analysis of 101 cases of triple negative breast cancer (TNBC):(1) Investigate TNBC patient’s mTOR and PD-L1 expression and its clinical significance and expression correlation with eachother; Analyze the clinical significance of their co-expression. (2) Explore the TCM Constitution distribution in TNBC, analyze the relationship between the TCM Constitution and PD-L1, mTOR expression.Methods:(1)Strictly to filter 143 cases of TNBC. (2)The expression of mTOR and PD-L1 was detected by immunohistochemistry. (3)Collect Clinicopathological parameters of patients enrolled and follow-up their survival prognosis. (4)Investigate and classify these patients’ TCM Constitution using "Chinese constitution classification and decision tables" that is formulated by Chinese Medical Association’s, (5)Organizing this data, then using SPSS18.0 statistical software to do statistical analysis.Results:(1) The positive expression rates of PD-L1 and mTOR was 51.5% and 34.7%, respectively, and there was a positive correlation between them (r=0.457, P=0.001, P<0.05). the expression of mTOR was associated with patient’s menopausal status, tumor size, lymph node metastasis, tumor stage and Ki-67 (P<0.05); while PD-L1 expression.was related to tumor size, lymph node metastasis and tumor stage (P<0.05); the rate of 3-year DFS in mTOR or PD-L1 positive was lower than that in the negative group (P<0.05); the survival curves of PD-L1 and mTOR separated, and further multivariate analysis showed that only PD-L1 may be independent prognostic risk factor of TNBC (P=0.001, P<0.05); co-expression of mTOR and PD-L1 revealed with the rate of 3-year DFS(P<0.05), but in survival analysis of four different forms of co-expression, the curve of mTOR, PD-L1 both positive and mTOR negative, PD-L1 positive was not clear separated. (3) According to the analysis of TCM Constitution questionnaire survey, among the TNBC patients, the main physical types are Qi-stagnation type, blood stasis type, phlegmatic hygrosis type and damp-heat type; Qi-stagnation constitution is associated with the expression of mTOR (P=0.030, P≤0.05).Conclusion:(1) The positive expression rate of mTOR and PD-L1 in TNBC is 51.5% and 34.7%, respectively, and the correlation between them was positive; The expression of mTOR was associated with menopausal status, tumor size, lymph node metastasis, tumor stage and Ki-67, while PD-L1 expression was related to tumor size, lymph node metastasis and tumor stage; 3-year recurrence and/or distant metastasis in PD-L1 positive group appeared significantly higher than that in the negative group; univariate analysis displayed that DFS was relevant to mTOR and PD-L1 expression, multivariate analysis showed that PD-L1 expression may be an independent prognostic factor of triple-negative breast cancer; co-expression of mTOR and PD-L1 was not observed a worse prognosis. (2) In terms of TCM constitution types, the majority of physical types of the TNBC patients are Qi-stagnation type and blood stasis type, Qi-stagnation constitution is associated with the expression of mTOR.