多区域免疫分析揭示了膀癌的预后模式
Nadia Jurczok1, Gabriel Dernbach2, Benedikt Ebner3
1Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
European urology oncology
|December 31, 2025
概括
一个新的免疫检查点蛋白 (ICP) 面板有效地分层了肌肉侵入性膀癌 (MIBC) 风险,优于目前的分期. 这种免疫分析方法指导预后和治疗决策,以获得更好的患者结果.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 病理学 病理学 病理学
背景情况:
- 肌肉侵入性膀癌 (MIBC) 是一种异质性疾病,预后可变.
- 传统的MIBC预后标志物是有限的.
- 瘤免疫微环境 (TIME) 越来越被认为是疾病进展和患者结果的关键因素.
研究的目的:
- 为了研究免疫检查点蛋白 (ICP) 在MIBC患者的时间中的预后价值.
- 根据ICP表达,为MIBC开发一个强大的风险分层模型.
- 确定瘤活检的最佳数量,以进行全面的免疫分析.
主要方法:
- 对251名接受囊切除术的MIBC患者的分析.
- 在瘤核心上使用免疫组织化学对六个ICP (IDO,PD-L1,PD-1,LAG-3,TIM-3,VISTA) 的量化.
- 对ICP阳性免疫和瘤细胞进行分层聚类,以定义TIME亚型.
- 多变量考克斯模型评估与整体存活率 (OS) 和无病存活率 (DFS) 的关联.
- 引导重新抽样以估计最大ICP表达的最小瘤样本数.
主要成果:
- IDO+和VISTA+免疫细胞占主导地位;PD-L1+瘤细胞表现为二分化的表达.
- 对于大多数ICP来说,三个空间区分的核心足够,而对于其他人来说,需要四个.
- 确定了三种TIME亚型 (CID1-3) ,其中CID3的预后明显较差 (中位数OS为18.5vs100.5个月,p=0.0007).
- 与国际癌症控制联盟分期相比,基于ICP的分类改善了患者分层,特别是在晚期MIBC中.
结论:
- 一个由六个标记器组成的多区域ICP小组为MIBC提供了强大的,独立于阶段的风险分层.
- 在MIBC中建议至少进行四次活检以进行常规免疫分析.
- 这种基于ICP的分层模型需要进一步的纵向外部验证.
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