Abstract:

Objective　To investigate the relationship of the expressions of vascular endothelial growth factor (VEGF) and programmed cell death 1 ligand 1 (PD-L1) with clinical pathological characteristics in patients with cervical cancer and HPV infection. Methods　Eighty patients with advanced cervical cancer treated at Yan'an Traditional Chinese Medicine Hospital from March 2016 to March 2021 were prospectively included in the study. They were (58.41±7.81) years old. There were 18 cases of high differentiation, 30 cases of moderate differentiation, and 32 cases of low differentiation. The immunohistochemical methods were used to detect the expressions of VEGF and PD-L1 in the collected tumor tissue slices. The correlation between VEGF and PD-L1 was analyzed. The Kaplan-Meier and Log-Rank methods were used to analyze the overall survival and differences between different subgroups. The Cox regression method was used to analyze the prognostic risk factors. Results　Among the 80 patients, 39 cases (48.75%) died from the progression of malignant tumors, and 41 cases (51.25%) still survived. The immunohistochemical results showed that the positive expression rates of VEGF and PD-L1 in the patients were 61.25% (49/80) and 52.50% (42/80), respectively. The Spearman correlation analysis showed a positive correlation between VEGF and PD-L1 (r=0.682, P=0.015). The expressions of VEGF and PD-L1 related to their degree of differentiation, distant metastasis, and FIGO stage (all P<0.05); the higher the FIGO stage and lower the degree of differentiation, the higher the relative expression levels of VEGF and PD-L1. The median OS of the patients with positive and negative VEGF expressions were 13.08 months and 14.73 months, respectively; the median OS of the patients with positive and negative PD-L1 expressions were 13.56 months and 15.12 months, respectively. The prognosis of the patients with negative VEGF expression was better than that of the patients with positive VEGF expression, and the prognosis of the patients with negative PD-L1 expression was better than that of the patients with positive PD-L1 expression (Log χ²=9.962 and 6.018; P<0.05). The Cox multivariate regression analysis suggested that VEGF expression, PD-L1 expression, distant metastasis, and FIGO staging were the risk factors affecting the patients' independent prognosis (HR=2.443, 2.251, 2.194, and 2.587; all P<0.05). Conclusion　VEGF and PD-L1 can serve as important indicators for evaluating the prognosis of patients with cervical cancer and HPV infection, and have certain clinical value.

Key words:

Cervical cancer, Human papilloma virus, Vascular endothelial growth factor, Programmed cell death 1 ligand 1, Correlation

摘要：

目的　研究宫颈癌患者合并人乳头瘤病毒（HPV）感染肿瘤组织中血管内皮生长因子（VEGF）和程序性死亡配体1（PD-L1）表达与临床病理特征的相关性。方法　前瞻性纳入2016年3月至2021年3月在延安市中医医院就诊的80例宫颈癌合并HPV感染患者，年龄（58.41±7.81）岁，分化程度：高分化18例、中分化30例、低分化32例。运用免疫组化方法检测肿瘤组织切片中VEGF和PD-L1的表达水平，Spearman法分析VEGF和PD-L1表达水平的相关性，Kaplan-Meier和Log-Rank法分析不同亚组之间总生存期及差异，Cox回归分析预后相关的风险因素。结果　80例患者中，39例（48.75%）死于恶性肿瘤的疾病进展，41例（51.25%）存活。免疫组化结果显示，VEGF和PD-L1在宫颈癌合并HPV感染肿瘤组织中的阳性表达率分别为61.25%（49/80）和52.50%（42/80）。Spearman相关性分析显示，VEGF与PD-L1的表达呈正相关（r=0.682，P<0.05）。VEGF、PD-L1表达均与患者的分化程度、远处转移、国际妇产科联盟（FIGO）分期有关（均P<0.05），且患者有远处转移、FIGO分期越高、分化程度越低，VEGF和PD-L1相对表达量就越高。VEGF表达阳性和阴性的中位总生存期（OS）分别为13.08个月、14.73个月，PD-L1表达阳性和阴性患者的中位OS分别为13.56个月和15.12个月，VEGF表达阴性患者的预后优于VEGF阳性患者，PD-L1表达阴性患者预后优于PD-L1表达阳性患者（Log χ²=9.962、6.018，均P<0.05）。Cox多因素回归分析提示VEGF表达、PD-L1表达、远处转移、FIGO分期是影响患者独立预后的风险因素［风险比（HR）=2.443、2.251、2.194、2.587，均P<0.05］。结论　VEGF和PD-L1检测可作为评估宫颈癌患者合并HPV感染预后的重要指标，具有一定的临床价值。

关键词:

宫颈癌, 人乳头瘤病毒, 血管内皮生长因子, 细胞程序性死亡-配体1, 相关性