目的 探讨免疫评分及PD-L1在肝癌组织的表达情况，分析肝癌患者的免疫评分与其临床病理特征及预后的关系。 方法 采用免疫组化检测免疫评分与PD-L1在61例肝癌患者中的表达，分析PD-L1、免疫评分与临床病理特征及预后之间的关系。 结果 肝癌中免疫评分较高的表达率为26.2%，较低的表达率为73.8%。统计分析发现免疫评分与AFP增高（P<0.05）及肝内复发（P>0.05）具有相关性；而与患者年龄、性别、肿瘤直径、分化程度、脉管癌栓等临床因素无相关性（P>0.05）。生存分析发现免疫评分较高患者的总生存期与无复发生存期显著高于免疫评分较低的患者（χ2=11.39，P<0.01；χ2=14.78，P<0.01）。肝癌组织PD-L1的阳性表达率为44.3%，对应癌旁低表达，具有统计学差异（χ2=7.313，P<0.01）。PD-L1阳性患者的总生存期与无复发生存期低于PD-L1阴性患者（χ2=5.598，P<0.05；χ2=10.90，P<0.01）。肝癌组织中PD-L1与免疫评分间具有负相关性（χ2=12.703，P<0.01）。 结论 免疫评分可作为患者预后的一个标志物，免疫评分高的患者预后较好，反之易早期复发且预后较差；肝癌组织PD-L1与免疫评分之间具有负相关性。
Objective To investigate the expression of immunoscore and PD-L1 in hepatocellular carcinoma(HCC), and to analyze the relationship between the expression of PD-L1 and immunoscore and the clinicopathological characteristics and prognosis of HCC. Methods Immunohistochemical staining was used to detect the expression of immunoscore and PD-L1 in 61 cases of hepatocellular carcinoma tissue, and to analyze the relationship between the expression of immunoscore and PD-L1 in hepatocellular carcinoma and different clinicopathological features and prognosis．Results The expression rate of high-immunoscore was 26.2%, the low-immunoscore expression rate was 73.8%. In clinical indicators，the positive expression rate of immunoscore was negatively related to patient's preoperative AFP level (P<0.005), and intrahepatic recurrence (P<0.05), but not to factors of patient’s age, gender, tumor size, differentiation, and non-vascular invasion correlated (P>0.05). Kaplan–Meier analysis presented that the immunoscore showed good stratification between high-immunoscore and low-immunoscore groups in both overall survival (P<0.01) and progression-free survival (P<0.01), respectively. The positive expression rate of PD-L1 in hepatocellular carcinoma was 44.3%, which was significantly higher than that in normal control group (P<0.01).Kaplan-Meier analysis presented that the PD-L1-positive patients was significantly lower in patients with negative PD-L1-negative patients. In clinical indicators，the positive expression rate of PD-L1 was negatively related to patient’s immunoscore (P<0.01)．Conclusions The expression of immunoscore can be used as an important prognostic maker for patients with hepatocellular carcinoma. Patients with high-immunoscore are significantly associated with a prolonged OS and PFS, however patients with low-immunoscore are more likely to occur early recurrence, prognosis is even worse. The positive expression rate of PD-L1 is negatively related to patient’s immunoscore.
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