%0 Journal Article
%T PD-L1表达与TILs浸润分型预测食管鳞癌免疫联合化疗疗效的临床研究
Clinical Research on Predicting the Efficacy of Immunotherapy Combined with Chemotherapy in Esophageal Squamous Cell Carcinoma Based on PD-L1 Expression and TILs Infiltration Typing
%A 刘林
%A 高会江
%A 石国栋
%A 艾江山
%A 赵连政
%A 张震
%A 兰亚良
%A 魏煜程
%J Advances in Clinical Medicine
%P 2064-2075
%@ 2161-8720
%D 2025
%I Hans Publishing
%R 10.12677/acm.2025.1541155
%X 目的：评估PD-L1表达(CPS)和TILs密度对ESCC免疫联合化疗疗效的预测能力，验证TIME分型体系，探索其临床转化潜力。方法：回顾性分析2017年1月至2024年12月青岛大学附属医院收治的238例初治ESCC患者，均接受PD-1/PD-L1抑制剂联合化疗。通过免疫组化检测PD-L1表达(CPS)和TILs密度，基于PD-L1 (CPS ≥ 10)和TILs (≥20%)将TIME分为四型(PD-L1+/TIL+、PD-L1+/TIL−、PD-L1−/TIL+、PD-L1−/TIL−)。采用Fisher-Freeman-Halton检验等统计学方法评估各型ORR差异，并用Kaplan-Meier法及Log-rank检验分析生存数据。结果：PD-L1阳性(CPS ≥ 10)和TILs高浸润(≥20%)患者ORR更高(PD-L1+ vs. PD-L1−: 34.9% vs. 20.8%, P = 0.030; TIL+ vs. TIL−: 42.7% vs. 7.4%, P < 0.001)。II型(PD-L1+/TIL+) ORR最高(44.55%)，显著优于其他亚型(vs. IV型：P < 0.001；vs. III型：P = 0.017；vs. I型：P = 0.025)；I型(PD-L1−/TIL−) ORR最低(12.50%)。生存分析显示，II型中位OS (37.4个月)和PFS (23.1个月)显著优于I型和IV型(Log-rank P < 0.001)。结论：TIME分型可有效预测ESCC免疫联合化疗的疗效和生存结局。II型为理想获益人群，I型及IV型需探索逆转免疫抑制的策略。
Objective: To assess the predictive value of PD-L1 expression (CPS) and TILs density for ICI-chemotherapy efficacy in ESCC patients and validate the TIME classification system. Methods: Retrospective analysis of 238 treatment-naïve ESCC patients receiving PD-1/PD-L1 inhibitors combined with chemotherapy from January 2017 to December 2024. PD-L1 (CPS) and TILs density were evaluated by immunohistochemistry. TIME was classified into four subtypes based on PD-L1 (CPS ≥ 10) and TILs (≥20%). ORR differences were assessed using Fisher-Freeman-Halton test, and survival data were analyzed using Kaplan-Meier and Log-rank tests. Results: PD-L1 positivity (CPS ≥ 10) and high TILs infiltration (≥20%) were associated with higher ORR (PD-L1+ vs. PD-L1−: 34.9% vs. 20.8%, P = 0.030; TIL+ vs. TIL−: 42.7% vs. 7.4%, P < 0.001). Type II (PD-L1+/TIL+) had the highest ORR (44.55%) which was significantly better than other subtypes (vs. Type IV: P < 0.001; vs. Type III: P = 0.017; vs. Type I: P = 0.025); Type I (PD-L1−/TIL−) had the lowest ORR (12.50%). Survival analysis showed that Type II had significantly longer median OS (37.4 months) and PFS (23.1 months) compared with Type I and Type IV (Log-rank P < 0.001). Conclusion: TIME classification effectively predicts the efficacy and survival outcomes of ICI-chemotherapy in ESCC patients. Type II
%K 食管鳞状细胞癌，
%K 肿瘤免疫微环境，
%K PD-L1，
%K 肿瘤浸润淋巴细胞
Esophageal Squamous Cell Carcinoma
%K Tumor Immune Microenvironment
%K PD-L1
%K Tumor-Infiltrating Lymphocytes
%U http://www.hanspub.org/journal/PaperInformation.aspx?PaperID=112054