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目的程序性死亡受体-配体1(programmed cell death-Ligand 1,PD-L1)在恶性肿瘤的免疫逃逸中起到重要作用。本研究采用Meta分析评价方法,探讨PD-L1表达与胃癌预后及临床病理特征的相关性。方法检索Medline/PubMed、EMBASE、Cochrane Library、Springer、万方、维普和中国知网等数据库,收集2016-05-25前公开发表的关于PD-L1表达与胃癌预后相关性的回顾性队列研究。采用RevMan5.3软件进行Meta分析,Newcastle-OttawaScale(NOS)量表进行文献质量评价,漏斗图评估文献的发表偏移。采用比值比(odds ratio,OR)及95%可信区间(confidence interval,CI)评价关联强度。结果共纳入8篇文献(1 322例患者)进行Meta分析。结果显示,PD-L1阳性表达与胃癌患者3年总体生存率(OR=2.88,95%CI:2.19~3.79,P<0.001)及5年总体生存率(OR=2.95,95%CI:1.70~5.10,P<0.001)降低有关。PD-L1表达差异与淋巴结转移(OR=3.32,95%CI:2.35~4.68,P<0.001)、肿瘤大小(OR=1.52,95%CI:1.12~2.05,P=0.007)有关,而与性别(OR=1.14,95%0.89~1.46,P=0.290)、分化程度(OR=1.02,95%CI:0.68~1.53,P=0.920)、浸润深度(OR=2.14,95%CI:0.93~4.94,P=0.080)、TNM分期(OR=1.99,95%CI:0.77~5.16,P=0.160)无关。结论 PD-L1与胃癌预后有关,其阳性表达在淋巴结转移阳性、肿瘤直径>5cm的胃癌患者中更常见。
OBJECTIVE: programmed cell death-Ligand 1 (PD-L1) plays an important role in the immune escape of malignant tumors. This study used Meta analysis to evaluate the relationship between PD-L1 expression and prognosis and clinicopathological features of gastric cancer. Methods A retrospective cohort study of the correlation between PD-L1 expression and prognosis of gastric cancer was collected before the publication of Medline / PubMed, EMBASE, Cochrane Library, Springer, Wanfang, VIP and CNKI. RevMan5.3 software was used for Meta analysis, the Newcastle-Ottawa Scale (NOS) scale was used to evaluate the quality of the literature, and the funnel plot was used to assess the publication bias of the literature. The odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the correlation strength. Results A total of 8 articles (1 322 patients) were included in the meta-analysis. The results showed that the positive expression of PD-L1 was associated with 3-year overall survival (OR = 2.88,95% CI: 2.19-3.79, P <0.001) and 5-year overall survival (OR = 2.95,95% CI: 5.10, P <0.001) decreased. The difference of PD-L1 expression was related to lymph node metastasis (OR = 3.32, 95% CI: 2.35-4.68, P <0.001) and tumor size (OR = 1.52, 95% CI: 1.12-2.05, P = 0.007) (OR = 1.14,95% 0.89-1.46, P = 0.290), the degree of differentiation (OR = 1.02,95% CI: 0.68-1.53, P = 0.920) , P = 0.080), TNM stage (OR = 1.99, 95% CI: 0.77-5.16, P = 0.160). Conclusions PD-L1 is associated with the prognosis of gastric cancer. The positive expression of PD-L1 is more common in patients with gastric cancer with positive lymph node metastasis> 5cm in diameter.