Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan.
Pathol Int. 2021 Jan;71(1):33-41. doi: 10.1111/pin.13048. Epub 2020 Dec 1.
The gastrointestinal tract is a rare site for metastatic lung cancer. Programmed cell death-ligand 1 (PD-L1) expression in lung cancer is a biomarker for the response to anti-PD-1/PD-L1 therapy. We investigated clinicopathological features and PD-L1 expression in 25 gastrointestinal metastatic tumors from the lung and primary adenocarcinoma of the small bowel. The small bowel was the most common site (16/25; 64%) of gastrointestinal tract lung cancer metastasis. A total of 19 (76%) of the gastrointestinal metastasis showed PD-L1 expression in ≥5% of tumor cells, with 14 (56%) showing high expression levels (≥50%). In contrast, 21 (84%) expressed PD-L1 in ≥5% immune cells, including 4 (16%) showing a high expression levels (≥50%). The PD-L1 expression on tumor cells and immune cells in primary lung cancer and corresponding gastrointestinal metastasis was concordant in 13 (68%) and 11 (58%) of the 19 paired cases, respectively. Small-bowel metastasis of lung cancer was characterized by a higher incidence of perforation (31% vs. 0%), ulcerated mass (83% vs. 60%), and neoplastic PD-L1 expression (75% vs. 0%) compared to primary small-bowel adenocarcinoma. Gastrointestinal metastasis from lung cancer might be a potential target for immune checkpoint inhibitor therapy, given its high expression of PD-L1.
胃肠道是肺癌转移的罕见部位。肺癌中程序性死亡配体 1（PD-L1）的表达是对抗 PD-1/PD-L1 治疗反应的生物标志物。我们研究了 25 例来自肺部的胃肠道转移性肿瘤和原发性小肠腺癌的临床病理特征和 PD-L1 表达。小肠是胃肠道肺癌转移的最常见部位（16/25；64%）。总共 19 例（76%）胃肠道转移显示肿瘤细胞中 PD-L1 表达≥5%，其中 14 例（56%）显示高表达水平（≥50%）。相比之下，21 例（84%）在≥5%的免疫细胞中表达 PD-L1，包括 4 例（16%）显示高表达水平（≥50%）。在 19 对配对病例中，肿瘤细胞和免疫细胞上的 PD-L1 表达在原发性肺癌和相应的胃肠道转移中分别有 13 例（68%）和 11 例（58%）是一致的。与原发性小肠腺癌相比，肺癌的小肠转移穿孔（31%对 0%）、溃疡性肿块（83%对 60%）和肿瘤 PD-L1 表达（75%对 0%）的发生率更高。鉴于其 PD-L1 的高表达，来自肺癌的胃肠道转移可能是免疫检查点抑制剂治疗的潜在靶点。
