北印度人群原发性中枢神经系统弥漫性大B细胞淋巴瘤中肿瘤免疫微环境和免疫检查点通路的预后意义
Prognostic implications of the tumor immune microenvironment and immune checkpoint pathway in primary central nervous system diffuse large B-cell lymphoma in the North Indian population.
作者信息
Parkhi Mayur, Chatterjee Debajyoti, Bal Amanjit, Vias Poorva, Yadav Budhi Singh, Prakash Gaurav, Gupta Sunil Kumar, Radotra Bishan Dass
机构信息
Department of Histopathology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
出版信息
APMIS. 2022 Feb;130(2):82-94. doi: 10.1111/apm.13195. Epub 2021 Dec 23.
Primary central nervous system-diffuse large B-cell lymphoma (PCNS-DLBCL) is a rare, extranodal malignant lymphoma carrying poor prognosis. The prognostic impact of tumor microenvironment (TME) composition and the PD-1/PD-L1 immune checkpoint pathway are still undetermined in PCNS-DLBCL. We aimed to quantify the tumor-infiltrating lymphocytes (TILs), tumor-associated macrophages (TAMs), and PD-L1 expression in the PCNSL and evaluated their prognostic significance. All patients with histopathologically diagnosed PCNS-DLBCL over a period of 7 years were recruited. Immunohistochemistry for CD3, CD4, CD8, FOXP3, CD68, CD163, PD-1, and PD-L1 was performed on the tissue microarray. Forty-four cases of PCNS-DLBCL, who satisfied the selection criteria, were included with mean age of 55 ± 12.3 years and male-to-female ratio of 0.91:1. The mean overall survival (OS) and disease-free survival (DFS) was 531.6 days and 409.8 days, respectively. Among TILs, an increased number of CD3+ T cells showed better OS and DFS, without achieving statistical significance. CD4 positive T-cells were significantly associated with the longer OS (p = 0.037) and DFS (p = 0.023). TAMs (68CD and CD163 positive) showed an inverse relationship with OS and DFS but did not reach statistical significance (p > 0.05). Increased PD-L1 expression in immune cells, but not in tumor cells, was associated with significantly better DFS (p = 0.037). The TME plays a significant role in the prognosis of PCNS-DLBCL. Increased number of CD4+ T cells and PD-L1-expressing immune cells is associated with better prognosis in PCNS-DLBCL. Further studies with larger sample size are required to evaluate the role of targeted therapy against the TME and immune check point inhibitors in this disease.
原发性中枢神经系统弥漫性大B细胞淋巴瘤(PCNS-DLBCL)是一种罕见的结外恶性淋巴瘤,预后较差。肿瘤微环境(TME)组成和PD-1/PD-L1免疫检查点通路对PCNS-DLBCL预后的影响仍未明确。我们旨在量化PCNSL中肿瘤浸润淋巴细胞(TILs)、肿瘤相关巨噬细胞(TAMs)和PD-L1的表达,并评估它们的预后意义。招募了所有在7年期间经组织病理学诊断为PCNS-DLBCL的患者。在组织芯片上进行CD3、CD4、CD8、FOXP3、CD68、CD163、PD-1和PD-L1的免疫组织化学检测。纳入44例符合选择标准的PCNS-DLBCL患者,平均年龄55±12.3岁,男女比例为0.91:1。平均总生存期(OS)和无病生存期(DFS)分别为531.6天和409.8天。在TILs中,CD3+T细胞数量增加显示出较好的OS和DFS,但未达到统计学意义。CD4阳性T细胞与较长的OS(p=0.037)和DFS(p=0.023)显著相关。TAMs(CD68和CD163阳性)与OS和DFS呈负相关,但未达到统计学意义(p>0.05)。免疫细胞而非肿瘤细胞中PD-L1表达增加与显著更好的DFS相关(p=0.037)。TME在PCNS-DLBCL的预后中起重要作用。CD4+T细胞数量增加和表达PD-L1的免疫细胞与PCNS-DLBCL的较好预后相关。需要进一步进行更大样本量的研究,以评估针对TME的靶向治疗和免疫检查点抑制剂在该疾病中的作用。