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. 2022 Jul;148(7):1803-1811.
doi: 10.1007/s00432-021-03772-7. Epub 2021 Aug 25.

Prognostic value of PD-L1 expression on immune cells or tumor cells for locally advanced esophageal squamous cell carcinoma in patients treated with neoadjuvant chemoradiotherapy

Ta-Chen Huang  1   2 , Cher-Wei Liang  3 , Yu-I Li  3 , Jhe-Cyuan Guo  2   4 , Chia-Chi Lin  2 , Ya-Jhen Chen  1 , Ann-Lii Cheng  5   6   7   8 , Chih-Hung Hsu  5   6   8
Affiliations

Prognostic value of PD-L1 expression on immune cells or tumor cells for locally advanced esophageal squamous cell carcinoma in patients treated with neoadjuvant chemoradiotherapy

Ta-Chen Huang et al. J Cancer Res Clin Oncol. 2022 Jul.

Abstract

Purpose: Programmed death-ligand 1 (PD-L1) expression may influence the prognosis of patients with localized esophageal cancer. The current study compared the prognostic value of PD-L1 expression between tumor cells and immune cells.

Methods: Archival esophageal tumor tissue samples were collected from patients who received paclitaxel and cisplatin-based neoadjuvant chemoradiotherapy (CRT) for locally advanced esophageal squamous cell carcinoma (ESCC) in three prospective phase II trials. PD-L1 expression on tumor and immune cells was examined immunohistochemically by using the SP142 antibody and scored by two independent pathologists. The association of PD-L1 expression with patient's outcomes was analyzed using a log-rank test and Cox regression multivariate analysis.

Results: A total of 100 patients were included. PD-L1 expression on tumor cells was positive (≥ 1%, TC-positive) in 55 patients; PD-L1 expression on immune cells was high (≥ 5%, IC-high) in 30 patients. TC-positive status was associated with poor overall survival (OS) (HR: 1.63, P = 0.035), whereas IC-high status was associated with improved OS (HR: 0.44, P = 0.0024). Multivariate analysis revealed that TC-positive, IC-high, and performance status were independent prognostic factors for progression-free survival and that IC-high and performance status were independent factors for OS. Furthermore, the combination of IC-high and TC-negative status was associated with the optimal OS, whereas that of TC-positive and IC-low status was associated with the worst OS.

Conclusion: PD-L1 expression on tumor and immune cells may have different prognostic value for patients with locally advanced ESCC receiving neoadjuvant CRT. A combination of these two indexes may further improve the prognostic prediction.

Keywords: Esophageal squamous cell carcinoma; Immune cells; Neoadjuvant chemoradiotherapy; PD-L1; Prognosis.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
a Overall survival and b progression to survival of the whole cohort
Fig. 2
Fig. 2
Immunohistochemical staining of PD-L1 with membranous expression on tumor cells (green arrows) and immune cells expression infiltrating tumor tissues (red arrows). Regions of negative staining are indicated by black arrows
Fig. 3
Fig. 3
Progression-free survival curves of patients with a TC-positive versus TC-negative and b IC-high versus IC-low. The survivals were compared by log-rank test
Fig. 4
Fig. 4
Overall survival curves of patients with a TC-positive versus TC-negative and b IC-high versus IC-low. The survivals were compared by log-rank test
Fig. 5
Fig. 5
Overall survival curves of four subgroups: TC-negative/IC-low, TC-positive/IC-low, TC-negative/IC-high, and TC-positive/IC-high. The survivals were compared by log-rank test
See this image and copyright information in PMC

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