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Scoring systems for PD-L1 expression and their prognostic impact in patients with resectable gastric cancer

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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 PD-L1 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.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP agency) – grant number 2016/25524-0.

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Authors and Affiliations

  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

    Marina Alessandra Pereira, Marcus Fernando Kodama Pertille Ramos, André Roncon Dias, Renan Ribeiro, Leonardo Cardili, Bruno Zilberstein, Ivan Cecconello, Ulysses Ribeiro Jr, Evandro Sobroza de Mello & Tiago Biachi de Castria

  2. Hospital Sírio Libanes , Sao Paulo, Brazil

    Tiago Biachi de Castria

Authors
  1. Marina Alessandra Pereira
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  2. Marcus Fernando Kodama Pertille Ramos
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  6. Bruno Zilberstein
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  8. Ulysses Ribeiro Jr
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  9. Evandro Sobroza de Mello
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  10. Tiago Biachi de Castria
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Contributions

Marina A. Pereira and Tiago Biachi de Castria: study design, data retrieval, critical analysis, and draft of the manuscript. Marcus F.K.P. Ramos: data retrieval, critical analysis, and review of the manuscript. Andre R. Dias: data retrieval and review of the manuscript. Marina A. Pereira, Renan R. Ribeiro, Leonardo Cardili, and Evandro S. Mello: laboratory techniques and pathological analysis. Ulysses Ribeiro Jr, Bruno Zilberstein, and Ivan Cecconello: implementation of the research, critical analysis, and reviews of the manuscript.

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Correspondence to Marina Alessandra Pereira.

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The authors declare that they have no conflicts of interest.

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The study was approved by the hospital ethics committee (NP1586/19) and registered online (www.plataformabrasil.com; CAAE: 2915516.2.0000.0065).

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Informed consent was waived by the local Ethics Committee in view of the retrospective nature of the study.

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Pereira, M.A., Ramos, M.F.K.P., Dias, A.R. et al. Scoring systems for PD-L1 expression and their prognostic impact in patients with resectable gastric cancer. Virchows Arch 478, 1039–1048 (2021). https://doi.org/10.1007/s00428-020-02956-9

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