Immune microenvironment in gallbladder adenocarcinomas
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.
Overview
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.
- 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.
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.
- 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.
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