# Immune microenvironment in gallbladder adenocarcinomas

Source: https://onco.cc/key-papers/paper-patil-gallbladder-immune-microenvironment-aimm-2021/  
OnCo record `paper-patil-gallbladder-immune-microenvironment-aimm-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A small United States series found PD-L1 in almost every gallbladder adenocarcinoma and PD-1-bearing immune cells in most, with the number of T cells in the stroma predicting survival differently in small and large tumours.

## Summary

PD-1 expression, not previously reported in gallbladder adenocarcinoma, was examined together with PD-L1 and T-cell markers in 47 cases. 98% (46 of 47) expressed PD-L1, 85% at 3+, and PD-1-positive tumour-infiltrating lymphocytes were present in 78.7% (37 of 47). Tumours with PD-1-positive lymphocytes were smaller and had more stromal CD3-positive T cells.

In tumours under 3 cm, stromal CD3 above 115 or CD8 above 45 per high-power field went with much better survival; in tumours of 3 cm or more, PD-1-positive lymphocytes or stromal CD8 above 45 per high-power field carried significantly poorer survival. PD-1 did not correlate with lymphovascular invasion, distant metastasis or stage; stage and age were the independent prognostic factors.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Applied Immunohistochemistry and Molecular Morphology
- Year: 2021
- DOI: 10.1097/pai.0000000000000922
- Authors: Patil PA, Lombardo K, Cao W.
- Findings: PD-L1 in 98% (46 of 47) of gallbladder adenocarcinomas, 85% at 3+; PD-1-positive infiltrating lymphocytes in 78.7%.; Tumours under 3 cm: stromal CD3 above 115 or CD8 above 45 per high-power field predicted better survival.; Tumours 3 cm or larger: PD-1-positive lymphocytes or high CD8 predicted worse survival.
- What it means: The 98% figure shows how much antibody and scoring choices matter: it sits against 14.7% and 23% in the two large series. The tumour-size-dependent effect of T-cell density is a hypothesis about immune exhaustion in bulkier tumours.
- Caveats: 47 cases from one centre; PD-L1 method and cut-off differ from the SP263 and TPS series.; Survival analyses in size-defined subgroups were small.

## Sources

- Patil et al., Appl Immunohistochem Mol Morphol 2021: immune microenvironment in 47 gallbladder adenocarcinomas: https://doi.org/10.1097/pai.0000000000000922
- PubMed: https://pubmed.ncbi.nlm.nih.gov/33710123/

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/)
- targets: [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/)
- terms: [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/), [Tumour-infiltrating lymphocytes (TILs)](https://onco.cc/terms/tils/)
- biomarkers: [PD-L1 TPS (tumour proportion score)](https://onco.cc/biomarkers/pd-l1-tps/)

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