Tumoral PD-L1 Expression as a Prognostic Marker in Invasive Cervical Cancer

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BACKGROUND/AIM: Cervical cancer (CC) remains one of the most common malignancies worldwide, particularly in low-resource countries. Expression of programmed death-ligand 1 (PD-L1) has emerged as an immune-related biomarker with predictive and potential prognostic relevance in several cancer types. However, its prognostic role in CC remains unclear. This study investigated the clinicopathological and prognostic significance of tumoral PD-L1 expression in CC. PATIENTS AND METHODS: This monocentric retrospective study included 113 patients diagnosed with invasive CC at the University Hospital Bonn between 2002 and 2016. Clinical and histopathological data were obtained from patient records, and immunohistochemical analyses were performed on tissue microarrays for PD-L1 [evaluated by Tumor Proportion Score (TPS) and Combined Positive Score (CPS)], p16, p53, Ki-67, and estrogen and progesterone receptors. RESULTS: PD-L1 expression was positive by TPS in 15.9% and CPS by 54.9% of cases. No significant association was found between PD-L1 expression and most clinicopathological parameters. In univariate analysis, increasing age was associated with worse overall survival (OS) and showed a trend towards reduced progression-free survival (PFS). Advanced International Federation of Gynecology and Obstetrics (FIGO) stage was associated with reduced PFS and OS. The presence of distant metastases was associated with worse OS but had no impact on PFS. Primary surgical treatment was associated with improved PFS and OS. Progesterone receptor positivity correlated with improved PFS. In multivariate analysis, PD-L1 positivity by CPS was independently associated with improved OS, whereas PD-L1 positivity by TPS was not. FIGO stage remained the dominant prognostic factor for OS. CONCLUSION: Tumoral PD-L1 expression, assessed by CPS, is an independent favorable prognostic factor for OS in CC, whereas TPS-based assessment lacked prognostic impact. CPS scoring may therefore provide superior biological and prognostic insight into PD-L1-related immune activity in CC.

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