Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Hematology-Oncology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
Oncology. 2021;99(6):365-372. doi: 10.1159/000514404. Epub 2021 Mar 17.
Biliary tract cancer (BTC) is associated with poor prognosis because of its aggressive and heterogeneous nature. Programmed death ligand 1 (PD-L1) has been considered a novel biomarker for prognosis and response of immune checkpoint inhibitors in various tumors. However, there are limited data reporting on the role of PD-L1 in advanced BTC patients.
We analyzed 186 patients with advanced BTC who received palliative gemcitabine and platinum between May 2010 and December 2019. All patients were evaluated for PD-L1 expression by combined positive score positivity.
Of the 186 patients, the primary tumor location was intrahepatic cholangiocarcinoma (IHCC) in 72 (38.7%), extrahepatic cholangiocarcinoma (EHCC) in 90 (48.4%), and gallbladder (GB) cancer in 24 (12.9%). Among all the patients, 53 (28.5%) had PD-L1 positivity. The median overall survival (OS) of patients with PD-L1 positivity or negativity was 12.1 and 15.4 months, respectively. The median progression-free survival (PFS) in patients with PD-L1 positivity or negativity was 5.7 and 7.1 months, respectively. OS and PFS were not statistically different between groups. In subgroup analysis, EHCC patients with PD-L1 negativity had more favorable OS (17.2 vs. 11.6 months, p = 0.002) and PFS (7.8 vs. 5.4 months, p = 0.005) than those who were PD-L1-positive. However, this finding was not reproduced in patients with IHCC or GB cancer.
This study demonstrated that PD-L1 expression might be a novel prognostic biomarker in patients with EHCC but not in patients with IHCC or GB cancer.
胆道癌（BTC）由于其侵袭性和异质性，预后较差。程序性死亡配体 1（PD-L1）已被认为是各种肿瘤中预测免疫检查点抑制剂疗效的新型生物标志物。然而，关于 PD-L1 在晚期 BTC 患者中的作用的研究数据有限。
我们分析了 2010 年 5 月至 2019 年 12 月期间接受姑息性吉西他滨和铂类化疗的 186 例晚期 BTC 患者。所有患者均采用联合阳性评分法评估 PD-L1 表达。
186 例患者中，肝内胆管癌（IHCC）72 例（38.7%），肝外胆管癌（EHCC）90 例（48.4%），胆囊（GB）癌 24 例（12.9%）。所有患者中，53 例（28.5%）PD-L1 阳性。PD-L1 阳性和阴性患者的中位总生存期（OS）分别为 12.1 个月和 15.4 个月。PD-L1 阳性和阴性患者的中位无进展生存期（PFS）分别为 5.7 个月和 7.1 个月。两组间 OS 和 PFS 无统计学差异。亚组分析显示，PD-L1 阴性的 EHCC 患者 OS（17.2 个月比 11.6 个月，p=0.002）和 PFS（7.8 个月比 5.4 个月，p=0.005）均优于 PD-L1 阳性患者。然而，这一发现并未在 IHCC 或 GB 癌患者中得到重现。
本研究表明，PD-L1 表达可能是 EHCC 患者的新型预后生物标志物，但在 IHCC 或 GB 癌患者中并非如此。
