Dermatologic surgery
Tumor programmed cell death ligand 1 expression correlates with nodal metastasis in patients with cutaneous squamous cell carcinoma of the head and neck

https://doi.org/10.1016/j.jaad.2017.05.047Get rights and content

Background

Binding of tumor-expressed programmed cell death ligand 1 (PD-L1) to the programmed cell death 1 (PD-1) surface receptor blocks T-cell activation thereby leading to immune evasion. Tumor PD-L1 expression has been associated with poor outcome in a wide variety of cancers; however, data in cutaneous squamous cell carcinoma (cSCC) are scarce and conflicting.

Objective

To investigate the relationship of tumor PD-L1 expression with the clinicopathologic features and prognosis of cSCC.

Methods

PD-L1 expression was analyzed by immunohistochemistry on paraffin-embedded tissue samples from 100 patients with cSCC. Cumulative/dynamic receiver operating characteristic curve was used to determine the optimal PD-L1 threshold. Kaplan-Meier estimators and Cox proportional hazards regression models were also used.

Results

On the basis of cumulative/dynamic receiver operating characteristic curves, we defined the cut-off score for PD-L1 expression as ≥25% of tumor cells positively stained. PD-L1 expression was a significant risk factor for nodal metastasis with crude and adjusted hazard ratios of 3.39 (1.71-6.65) and 6.54 (2.28-18.78), respectively.

Limitations

This is a retrospective study limited to cSCC of the head and neck.

Conclusion

These findings indicate that tumor PD-L1 expression predicts increased risk for nodal metastasis in patients with cSCC.

Section snippets

Patients and procedures

The Department of Pathology electronic database at Hospital Universitario Central de Asturias was searched to locate all the patients who had developed nodal metastases from cSCC of the head and neck (cSCCHN) during 1998-2008. Two of the authors (Drs García-Pedrero and Munguia-Calzada) read the reports identified by this search. All the electronic medical records were reviewed (by Drs García-Pedrero and Munguía-Calzada), and information regarding clinical variables, date of nodal metastasis,

Results

In total, 100 white patients were enrolled in the study; 78 (78%) were men, and their mean age was 79 years (Table II). PD-L1 expression was observed in ≥1% of tumor cells in 41 (41%) patients (Table I). Tumor cell cytoplasmic membranes were positive for PD-L1 (Fig 1). Cytoplasmic PD-L1 staining of carcinoma cells was not considered.

Youden's index analysis indicated that the optimal cut-off to use to consider a patient positive for PD-L1 expression was ≥25% tumor cell positivity. A total of 13

Discussion

In this study, we assessed the role of tumor PD-L1 expression as a predictive factor for nodal metastases and survival in cSCCHN. Similar to previous studies,5, 7, 8, 9 we retrospectively analyzed PD-L1 expression in our cohort of cSCCHN patients.

PD-L1 is found mainly expressed on the surface of tumor cells and antigen-presenting cells of various solid malignancies, such as cSCCHN; melanoma; and carcinomas of the brain, thyroid, thymus, esophagus, lung, breast, gastrointestinal tract,

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    Funding sources: Supported by grants from the Plan Nacional de I+D+I 2013-2016 ISCIII (CP13/00013 and PI13/00259 to Dr García-Pedrero), PI16/00280 and Centro de Investigación Biomédica en Red de Cáncer (CB16/12/00390) Spain, and the European Regional Development Fund.

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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