收稿日期: 2025-07-10
修回日期: 2025-08-16
录用日期: 2025-08-21
网络出版日期: 2026-01-22
基金资助
省部共建中亚高发病成因与防治国家重点实验室巴州工作站（巴州人民医院）2024年联合基金项目(SKL-HIDCA- 2024-BZ18)
Expression correlation of PD⁃L1 and Her⁃2 in invasive urothelial carcinoma and their impact on prognosis
Received date: 2025-07-10
Revised date: 2025-08-16
Accepted date: 2025-08-21
Online published: 2026-01-22
目的 探讨程序性死亡配体-1（PD-L1）与人表皮生长因子受体-2（HER2）在浸润性尿路上皮癌（IUC）中的表达相关性及其对患者预后的影响，为精准分层治疗及预后评估提供依据。 方法 纳入2021年5月至2024年5月收治的60例IUC患者，采用免疫组化法检测肿瘤组织中HER2和PD-L1的表达水平，分析二者与临床病理参数（肿瘤分化程度、TNM分期、淋巴结转移等）的相关性；通过Kaplan-Meier法和Log-rank检验比较不同表达状态患者的无进展生存期（PFS）和总生存期（OS），并通过Cox比例风险回归模型筛选预后独立危险因素；进一步评估HER2与PD-L1联合检测对预后不良的诊断效能。 结果 HER2阳性率为38.33%（23/60），PD-L1高表达率为41.67%（25/60）；二者表达均与肿瘤低分化（r = 0.360/0.280，P < 0.05）、临床分期Ⅲ—Ⅳ期（r = 0.395/0.325，P < 0.05）呈正相关。多因素分析显示，HER2阳性（HR = 1.878，P = 0.042）、PD-L1高表达（HR = 1.822，P = 0.039）为预后不良的独立危险因素。HER2与PD-L1联合检测的AUC为0.830（P < 0.001），灵敏度82.14%，特异度81.25%，显著优于单一指标（P < 0.05）。 结论 HER2阳性与PD-L1高表达是IUC患者肿瘤进展及预后不良的独立危险因素，二者联合检测可提高预后评估效能，为IUC的精准分层治疗提供了新的生物标志物组合。
关键词： 浸润性尿路上皮癌; 程序性死亡配体-1; 人表皮生长因子受体-2; 预后; 生物标志物
李雯 , 黄海生 , 黄斌 , 韩莉 . 程序性死亡配体-1、人表皮生长因子受体-2在浸润性尿路上皮癌中的表达相关性及对预后影响[J]. 实用医学杂志, 2026 , 42(2) : 194 -200 . DOI: 10.3969/j.issn.1006-5725.2026.02.004
Objective To investigate the expression correlation of PD-L1 and Her-2 in invasive urothelial carcinoma （IUC） and their impact on patient prognosis， providing a basis for precise stratified treatment and prognostic evaluation. Methods A total of 60 IUC patients were included from May 2021 to May 2024. Immunohistochemistry was used to detect the expression levels of Her-2 and PD-L1 in tumor tissues. The correlation between their expressions and clinicopathological parameters （tumor differentiation grade， TNM stage， lymph node metastasis， etc.） was analyzed. Kaplan-Meier method and Log-rank test were used to compare progression-free survival （PFS） and overall survival （OS） among patients with different expression statuses. Cox proportional hazard regression model was applied to identify independent prognostic risk factors. Additionally， the diagnostic efficacy of combined Her-2 and PD-L1 detection for poor prognosis was evaluated. Results The positive rate of Her-2 was 38.33% （23/60）， and the high expression rate of PD-L1 was 41.67% （25/60）. Both expressions were positively correlated with low tumor differentiation （r = 0.360/0.280， P < 0.05） and clinical stage Ⅲ—Ⅳ （r = 0.395/0.325， P < 0.05）. Multivariate analysis revealed that Her-2 positivity （HR = 1.878， P = 0.042） and high PD-L1 expression （HR = 1.822， P = 0.039） were independent risk factors for poor prognosis. The AUC of combined Her-2 and PD-L1 detection was 0.830 （P < 0.001）， with a sensitivity of 82.14% and specificity of 81.25%， which was significantly better than single indicators （P < 0.05）. Conclusions Her-2 positivity and high PD-L1 expression are independent risk factors for tumor progression and poor prognosis in IUC patients. Combined detection of the two can improve the efficacy of prognostic evaluation and provide a new biomarker combination for precise stratified treatment of IUC.
Key words： invasive urothelial carcinoma; PD-L1; Her-2; prognosis; biomarker
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