Prognostic value of the association between MHC class I downregulation and PD-L1 upregulation in head and neck squamous cell carcinoma patients

Abstract

The purpose of this study was to evaluate the prognostic impact of major histocompatibility complex (MHC) class I expression and programmed death-ligand 1 (PD-L1) expression in patients with head and neck squamous cell carcinoma (HNSCC). A total of 158 patients with HNSCC were evaluated retrospectively. The expression of MHC class I and PD-L1 was analyzed in tumor specimens using immunohistochemistry. The association between MHC class I/PD-L1 expression and clinical outcome was evaluated by Kaplan-Meier and Cox regression analyses. Among 158 patients, 103 (65.2%) showed positive PD-L1 expression, and 20 (12.7%) showed no detectable expression of MHC class I. The frequency of PD-L1 positive expression with concomitant MHC class I loss was 7.0%. In the PD-L1-positive group, MHC class I loss was associated with a significantly worse survival compared with MHC class I positivity (median overall survival 39.3 months vs. not reached; P = 0.005), whereas MHC class I status provided no prognostic impact in the PD-L1 negative group. Neither PD-L1 nor MHC class I alone showed a significant difference in overall survival. The loss of MHC class I expression in PD-L1-positive HNSCC was associated with a poor clinical outcome. This suggested that MHC class I expression status might be useful for the prognosis of tumor progression in HNSCC when combined with PD-L1 expression status. External validation with enough numbers of participants in such subgroup should be needed for validation.

Figure 1

Major histocompatibility complex (MHC) class I and programmed death-ligand 1 expression in head and neck squamous cell carcinoma patients. Representative immunohistochemical staining for MHC class I on paraffin. MHC class I expression is undetectable (A), weak (B), or strong (C).

Figure 2

Kaplan-Meier curves for overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC). OS stratified by programmed death-ligand 1 expression status (A) and OS stratified by major histocompatibility complex class I expression status (B). mOS median overall survival, nr not reached.

Figure 3

Kaplan-Meier curves for overall survival (OS) according to PD-L1 status in head and neck squamous cell carcinoma (HNSCC) patients stratified by MHC class I expression. OS stratified by major histocompatibility complex (MHC) class I expression in programmed death-ligand 1 (PD-L1)-positive HNSCC patients (A) and OS stratified by MHC class I expression in PD-L1-negative HNSCC patients (B). mOS median overall survival, nr not reached.