高肿瘤突变负担与阴茎鳞状细胞癌中 PD-L1 强表达、HPV 阴性和更差的生存相关:165 例分析。

High tumour mutational burden is associated with strong PD-L1 expression, HPV negativity, and worse survival in penile squamous cell carcinoma: an analysis of 165 cases.

机构信息

Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic.

Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.

出版信息

Pathology. 2024 Apr;56(3):357-366. doi: 10.1016/j.pathol.2023.10.010. Epub 2023 Dec 1.

Abstract

Penile squamous cell carcinoma (pSCC) is a rare tumour with a variable prognosis. More prognostic markers linked to mutational signatures and the tumour immune microenvironment are needed. A cohort made up of 165 invasive pSCC was retrospectively analysed using formalin-fixed, paraffin-embedded tumour tissue, focusing on tumour mutational burden (TMB), programmed death ligand 1 (PD-L1) expression, microsatellite instability (MSI), the number of tumour infiltrating lymphocytes (TILs) expressing cytotoxic T-lymphocyte-associated protein 4 (CTLA4), HPV status determined by p16 immunohistochemistry, and several traditional histopathological variables. High TMB (>10 mut/Mb) was associated with high PD-L1 expression (TPS 50-100%), and HPV-negative status. High PD-L1 expression was linked to HPV negativity, a high number of intratumoural CTLA4+ cells, and brisk lymphocytic infiltrate. High TMB was a significant predictor of shorter overall survival (OS) in both univariate and multivariate analysis when using a median cut-off value of 4.3 mut/Mb, but not when using an arbitrary cut-off of 10 mut/Mb. Low CTLA4+ cell infiltration at the tumour invasion front was a marker of shorter OS and cancer-specific survival in both univariate and multivariate analysis. PD-L1 expression had no significant impact on prognosis. Only two cases were MSI high. The results support the hypothesis of two aetiological pathways in pSCC cancerogenesis: (1) SCC linked to HPV infection characterised by low TMB, less common PD-L1 expression, and a lower number of TILs; and (2) SCC linked to chronic inflammation leading to a high number of acquired mutations (high TMB), HPV negativity, increased neoantigen production (i.e., PD-L1), and high immune cell infiltration.

摘要

阴茎鳞状细胞癌(pSCC)是一种罕见的肿瘤,预后不一。需要更多与突变特征和肿瘤免疫微环境相关的预后标志物。本研究回顾性分析了 165 例侵袭性 pSCC 的病例,使用福尔马林固定、石蜡包埋的肿瘤组织,重点关注肿瘤突变负担(TMB)、程序性死亡配体 1(PD-L1)表达、微卫星不稳定性(MSI)、表达细胞毒性 T 淋巴细胞相关蛋白 4(CTLA4)的肿瘤浸润淋巴细胞(TILs)数量、p16 免疫组化检测的 HPV 状态,以及几种传统的组织病理学变量。高 TMB(>10 mut/Mb)与高 PD-L1 表达(TPS 50-100%)和 HPV 阴性有关。高 PD-L1 表达与 HPV 阴性、肿瘤内 CTLA4+细胞数量高和淋巴细胞浸润活跃有关。当使用中位数截断值 4.3 mut/Mb 时,高 TMB 是总生存期(OS)的单因素和多因素分析中的显著预测因素,但当使用任意截断值 10 mut/Mb 时则不然。肿瘤侵袭前沿低 CTLA4+细胞浸润是单因素和多因素分析中 OS 和癌症特异性生存的短缩标志物。PD-L1 表达对预后没有显著影响。只有 2 例为 MSI 高。结果支持 pSCC 发生机制中有两种病因途径的假说:(1)与 HPV 感染相关的 SCC 特征为低 TMB、较少见的 PD-L1 表达和较少的 TILs;(2)与慢性炎症相关的 SCC 导致大量获得性突变(高 TMB)、HPV 阴性、新生抗原产生增加(即 PD-L1)和高免疫细胞浸润。

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