서울의대 / 김규보*
그림 1. (A) PD-L1 면역조직화학염색 결과의 대표 슬라이드 (B) PD-1+/CD8+ TIL 비율이 높은 종양의 PD-1, CD8 면역조직화학염색 결과 (C) PD-1+/CD8+ TIL 비율이 낮은 종양의 PD-1, CD8 면역조직화학염색 결과
그림 2. PD-1+/CD8+ TIL 비율에 따른 생존 곡선 비교 (A) 전체 생존율 (B) 무재발 생존율
Abstract
BACKGROUND AND PURPOSE:
This study investigated the prognostic role of PD-L1 expression, PD-1(+) tumor-infiltrating lymphocytes (TILs), and the ratio of PD-1(+)/CD8(+) TILs in extrahepatic bile duct (EHBD) cancer.
MATERIALS AND METHODS:
We analyzed 83 patients with EHBD cancer who underwent curative surgery plus fluoropyrimidine-based chemoradiotherapy (CRT). Expressions of PD-L1, PD-1, and CD8 were assessed by immunohistochemistry.
RESULTS:
Fifty-six (68%) patients were PD-L1-positive, and its lower expression level was associated with hilar tumor location (P=0.044). A higher ratio of PD-1(+)/CD8(+) TILs was associated with poorer overall survival (OS) (P=0.032), relapse-free survival (RFS) (P=0.024), and distant metastasis-free survival (DMFS) (P=0.039) in Kaplan-Meier analyses, but survival differences were not observed according to the PD-L1 expression level. With Cox proportional hazards models, the ratio of PD-1(+)/CD8(+) TILs was the independent prognostic factor in OS (HR 2.47, 95% CI 1.04-5.86), RFS (HR 2.41, 95% CI 1.08-5.41), and DMFS (HR 2.67, 95% CI 1.00-7.11) after adjusting for other significant clinicopathologic variables.
CONCLUSION:
A strong survival impact of the ratio of PD-1(+)/CD8(+) TILs was observed in EHBD cancer. In the poor prognostic subgroup, the blockade of the immune checkpoint in combination with conventional multimodality treatment needs to be considered.
Author information
Lim YJ1, Koh J2, Kim K3, Chie EK4, Kim B5, Lee KB6, Jang JY7, Kim SW8, Oh DY9, Bang YJ10, Ha SW11.
1Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea. Electronic address: yujindw@gmail.com.
2Department of Pathology, Seoul National University College of Medicine, Republic of Korea. Electronic address: tarda@naver.com.
3Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea. Electronic address: kyubokim@snu.ac.kr.
4Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Republic of Korea. Electronic address: ekchie93@snu.ac.kr.
5Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea. Electronic address: merdeglas@hanmail.net.
6Department of Pathology, Seoul National University College of Medicine, Republic of Korea. Electronic address: kblee@snuh.org.
7Department of Surgery, Seoul National University College of Medicine, Republic of Korea. Electronic address: jangjy4@gmail.com.
8Department of Surgery, Seoul National University College of Medicine, Republic of Korea. Electronic address: sunkim@snu.ac.kr.
9Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea. Electronic address: ohdoyoun@snu.ac.kr.
10Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea. Electronic address: bangyj@snu.ac.kr.
11Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Republic of Korea. Electronic address: swha@snu.ac.kr.