Scoring systems for PD-L1 expression and their prognostic impact in patients with resectable gastric cancer
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ORIGINAL ARTICLE
Scoring systems for PD-L1 expression and their prognostic impact in patients with resectable gastric cancer Marina Alessandra Pereira 1 & Marcus Fernando Kodama Pertille Ramos 1 & André Roncon Dias 1 & Renan Ribeiro 1 & Leonardo Cardili 1 & Bruno Zilberstein 1 & Ivan Cecconello 1 & Ulysses Ribeiro Jr 1 Evandro Sobroza de Mello 1 & Tiago Biachi de Castria 1,2
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Received: 2 September 2020 / Revised: 5 October 2020 / Accepted: 19 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The combined positive score (CPS) and tumor proportion score (TPS) have been developed to evaluate programmed death ligand-1 (PD-L1) expression, especially due to the potential benefit of the targeted therapy. However, the prognostic value of PDL1 scoring systems in gastric cancer (GC) remains unclear. This study aimed to evaluate PD-L1 expression according to CPS and TPS in curative resected GC patients and its correlation with prognosis. We retrospectively evaluated 284 GC patients who underwent D2-gastrectomy by tissue microarray. PD-L1 expression was analyzed by immunohistochemistry. PD-L1 positivity by CPS and TPS was observed in 45 (15.8%) and 34 (12%) patients, respectively. Larger tumor size (p = 0.028), undetermined Lauren type (p < 0.001), and heavy inflammatory infiltrate (p = 0.009) were associated with CPS-positive GC. TPS-positive were more frequent in patients with larger tumor size (p = 0.004), undetermined type (p < 0.001), moderate/severe inflammatory infiltrate (p = 0.001), total gastrectomy (p = 0.036), and poorly differentiated histology (p = 0.025). No differences were observed in the pT, pN, and pTNM status according to the PD-L1 scores. Both scores were associated with Epstein-Barr virus positivity, microsatellite instability and p53-normal expression. The disease-free survival (DFS) was worse for CPS-negative compared to CPS-positive group (p = 0.052). No difference was observed between TPS-positive and negative groups (p = 0.436). Total gastrectomy, advanced pT status, and CPS-negative were independent factor for worse survival in GC. CPS was an independent prognostic factor for survival and could be used as a prognostic biomarker in patients with resectable GC. Keywords Gastric cancer . Programmed death ligand-1 . Targeted therapy . Immunotherapy . Combined positive score
Introduction Gastric cancer (GC) is a heterogeneous disease and the multimodal treatment is the main way to achieve better outcomes in locally advanced disease. In addition to surgery and traditional chemotherapy regimens, the immune checkpoint pathways Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00428-020-02956-9) contains supplementary material, which is available to authorized users. * Marina Alessandra Pereira [email protected] 1
Instituto do Cancer do Estado de São Paulo (ICESP), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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Hospital Sírio Li
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