Prognostic role of PD-L1 and immune-related gene expression profiles in giant cell tumors of bone


Giant cell tumor of bone (GCTB) is a locally aggressive and rarely metastatic tumor, with a relatively unpredictable clinical course. A retrospective series of 46 GCTB and a control group of 24 aneurysmal bone cysts (ABC) were selected with the aim of investigating the PD-L1 expression levels and immune-related gene expression profile, in correlation with clinicopathological features. PD-L1 and Ki67 were immunohistochemically tested in each case. Furthermore, comprehensive molecular analyses were carried out using NanoString technology and nCounter PanCancer Immune Profiling Panel, and the gene expression results were correlated with clinicopathological characteristics. PD-L1 expression was observed in 13/46 (28.3%) GCTB (and in 1/24, 4.2%, control ABC, only) and associated with a shorter disease free interval according to univariate analysis. Moreover, in PD-L1-positive lesions, three genes (CD27, CD6 and IL10) were significantly upregulated (p < 0.01), while two were downregulated (LCK and TLR8, showing borderline significance, p = 0.06). Interestingly, these genes can be related to maturation and immune tolerance of bone tissue microenvironment, suggesting a more immature/anergic phenotype of giant cell tumors. Our findings suggest that PD-L1 immunoreactivity may help to select GCTB patients with a higher risk of recurrence who could potentially benefit from immune checkpoint blockade.

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Aneurysmal bone cyst


Disease-free interval


Formalin-fixed paraffin embedded


Giant cell


Giant cell tumor of bone


Hematoxylin and eosin




Mononuclear tumor cell


Standard deviation


World Health Organization


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We would like to thank Mr. Lorenzo Visca for his skillful technical assistance. This study is dedicated to the memory of Tom, an extraordinarily lively boy who untimely died of cancer.


This work was partially supported by an unrestricted grant (1704/2018) from the “Fondazione per i Tumori muscolo scheletrici,” Torino. In addition, this research received funding specifically dedicated to the Department of Medical Sciences from Italian Ministry for Education, University and Research (Ministero dell’Istruzione, dell’Università e della Ricerca—MIUR) under the program “Dipartimenti di Eccellenza 2018–2022,″ Project no D15D18000410001. JM and LB are PhD fellows at the University of Turin. LA is funded by Fondazione Umberto Veronesi (Postdoctoral fellowship 2018 and 2019).

Author information




MP designed and supervised the study. JM and AL collected the data and prepared the material. LA, JM, CM, FV and CV analyzed the samples. AC, GG, RP and NR treated and followed patients and provided clinical data. SOA performed statistical analyses. MP, JM, LA, SOA, AL, LB and PC contributed to data interpretation. The first draft of the manuscript was written by MP and JM, and all authors critically revised the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Mauro Papotti.

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The authors declare that they have no conflict of interest.

Ethical approval and ethical standards

This study was conducted in accordance with the ethical standards of the Declaration of Helsinki, and approval was granted by the Research Ethics Committee for Human Biospecimen Utilization (Department of Medical Sciences—ChBU) of the University of Turin (n° 10/2019). This study does not contain any studies with human participants or animals performed by any of the authors.

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Before the study started, all cases were de-identified and coded by a pathology staff member not involved in the study, and all data were accessed anonymously. Considering the retrospective nature of this research protocol with no impact on patients’ treatment and the use of anonymized data only, no written consent was required by the Committee.

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Metovic, J., Annaratone, L., Linari, A. et al. Prognostic role of PD-L1 and immune-related gene expression profiles in giant cell tumors of bone. Cancer Immunol Immunother 69, 1905–1916 (2020).

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  • Giant cell tumor of bone
  • PD-L1
  • Immune-related genes
  • NanoString technology
  • Prognosis