Résumé
BACKGROUND@#Tumor microenvironment is a complex and dynamic community, which plays a crucial role in tumor progression via the co-evolution of cancer cells and tumor stroma. Among them, tumor-associated macrophages (TAMs) and tumor neo-vessels are two key components in the tumor microenvironment during cancer invasion. In addition, programmed cell death ligand 1/programmed cell death ligand 1 (PD-1/PD-L1) also plays an important role in tumorigenesis and development, and the clinical strategies to block PD-1/PD-L1 pathway could have great benefits for cancer patients. This study was aimed at analyzing the quantitative expression and prognostic significance of TAMs, tumor neo-vessels and PD-L1 in tumor microenvironment and exploring the relations between the expression of above components with the patients' prognosis of non-small cell lung cancer (NSCLC).@*METHODS@#Clinico-pathological data and surgical specimens of 92 patients with NSCLC were collected, and immunohistochemistry was used to stain the expression of TAMs, tumor neo-vessels and PD-L1 on tumor tissue and peri-tumor tissues. The inverted microscopy was used to take pictures and Image-pro Plus 6.0 software was used for quantitative analysis. The clinicopathological characteristics and overall survival (OS) were analyzed.@*RESULTS@#The median OS of 92 NSCLC cases was 22.5 month. The expression of TAMs, tumor neo-vessels and PD-L1 in tumor tissue and peri-tumor tissues were not statistically significant (P>0.05). According to the cutoff of above key three components in tumor microenvironment, all the cases could be classified into high, middle and low expression groups. The survival analysis demonstrated that the OS in high expression group of TAMs (P=0.016) and PD-L1 (P=0.002) was shorter than the other two groups, respectively, with statistical significance. The OS in high tumor neo vessels group was shorter than the other two groups. However, there was no statistical significance between these three group (P=0.626). Combined with above the three components, all the cases could be classified into low, middle and high density groups. The survival analysis demonstrated that the median OS of combined high density group was shorter than the other two groups (P=0.001). Multivariate analysis by Cox regression indicated that pathological type, TAMs and PD-L1 expression were the independent prognostic factors.@*CONCLUSIONS@#The key components of TAMs and PD-L1 in tumor microenvironment are closely related to the prognosis of NSCLC patients.
Résumé
Objective To investigate the value of superb micro-vascular imaging (SMI) in evaluating the relationship between neovascularization in carotid atherosclerotic plaque and clinical symptoms.Methods A total of 146 patients with carotid atherosclerotic plaque which were found by ultrasonography were selected from March 2015 to February 2017 in the Central Hospital of Jiading District of Shanghai.The patients were divided into clinical symptom group(n =96) and symptomless group (n =50) according to cerebrovascular events.The neovessels of carotid atherosclerotic plaque was observed and classified by SMI and contrast-enhanced ultrasound (CEUS).The relationship between the degree of neovascularization and clinical symptoms was analyzed by univariate analysis and multivariate analysis.SMI and GEUS were compared by consistency analysis,and the sensitivity and specificity of the two methods were analyzed.Results The average thickness of carotid atherosclerotic plaques in clinical symptoms group and symptomless group was (3.09 ± 0.79) and (2.89 ± 0.49) mm respectively,there was no significant difference between the two groups (P ＞ 0.05).There were 80 (83.33％) patients with neovascularization in carotid atherosclerotic plaque in the clinical symptoms group,and there were 20 (40.00％) patients with neovascularization in carotid atherosclerotic plaque in the symptomless group,the proportion of patients with neovascularization in carotid atherosclerotic plaque in the clinical symptoms group was significantly higher than that in the symptomless group (Z =-6.488,P ＜0.05).The SMI classification was in good agreement with the CEUS classification in the two groups (P ＜ 0.05).SMI showed the blood flow signal within carotid plaque in 100 cases,including 80 cases in the clinical symptoms group and 20 cases in the symptomless group.SMI showed no blood flow signal within the carotid plaques in 46 cases,including 16 cases in the clinical symptoms group and 30 cases in the symptomless group.GEUS showed the blood flow signal within carotid plaque in 109 cases,including 81 cases in the clinical symptoms group and 28 cases in the symptomless group.GEUS showed no blood flow signal within the carotid plaques in 37 cases,including 15 cases in the clinical symptoms group and 22 cases in the symptomless group.The sensitivity and specificity of SMI predicting the occurrence of clinical symptoms was 83.3％ and 40.00％ respectively.The sensitivity and specificity of GEUS predicting the occurrence of clinical symptoms was 84.4％ and 56.00％ respectively.Conclusions SMI can easily detect neovessels in carotid atherosclerotic plaques,and the degree of neovascularization is related to the occurrence of clinical symptoms.SMI technique plays an important role in evaluating the neovascularization in carotid plaques.