Programmed death ligand-1 (PD-L1) is an independent negative prognosticator in Western-world gallbladder cancer
In 131 German gallbladder cancers about one in seven had PD-L1 on tumour cells and fewer than one in twenty had a lot; high PD-L1 marked poorly differentiated tumours and shorter survival, and a second checkpoint, TIGIT, was present in some.
Overview
PD-L1 was assessed immunohistochemically in 131 gallbladder cancer patients as tumour proportion score (TPS), immune cell score and combined positive score. Tumour cells expressed PD-L1 in 14.7% of patients at a TPS cut-off of 1%; TPS above 10% and 25% was reached in 4.7% and 3.1%. At the 10% cut-off, TPS was associated with distinct histomorphological subtypes and poor differentiation.
Survival analysis showed a TPS above 10% to be a highly significant and independent negative prognosticator. PD-L1 expression was associated with increased CD4-positive, CD8-positive and PD-1-positive immune cell densities. In 14.8% of cases scattered immune cells expressed TIGIT, correlated with tumour expression of its ligand CD155.
- PD-L1 TPS 1% or more in 14.7%, above 10% in 4.7%, above 25% in 3.1% of 131 Western gallbladder cancers.
- TPS above 10% an independent negative prognostic factor, linked to poor differentiation and denser CD4, CD8 and PD-1 infiltrates.
- TIGIT on scattered immune cells in 14.8%, correlated with tumoral CD155.
The Western counterpart to the Indian series, with lower rates and a prognostic signal in the opposite direction from what immunotherapy enthusiasts might hope. The TIGIT and CD155 finding names a second checkpoint for future trials.
- Single German centre; 131 patients.
- Scoring systems and clone differ from the Indian study, so the rates are not directly comparable.
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