EC Gynaecology

Background: In Thailand, Endometrial cancer (EC) is the fifth female cancer. Immunity is a hallmark of cancer development and regulates tumor growth. PD-L1 intensity correlated with the immune evasion and the prognosis of disease. Many studies showed that PD-L1 is expressed in EC and its intensity associates with the response of anti-PD-L1.

Objective: To evaluate the frequency of PD-L1 of EC patients and to compare expression of PD-L1, CD3, CD45, MSH6, PMS2, p53 with clinicopathological character.

Material and Methods: A retrospective cohort study was collected of endometrial cancer patients who diagnosed and underwent surgery at Rajavithi Hospital from January 2013 to December 2014. The demographic data and survival data were collected. Specimens were reviewed and immunohistochemistry data was interpreted by pathologist. Kaplan-Meier method, log-rank tests and the multivariable Cox proportional hazards regression analyses were used for statistical analysis.

Results: Of 129 Thai EC patients, 33 patients (25.6%) were positive for PD-L1, 61 patients (47.3%) were absented mismatch repair (MMR) protein, 42 patients (32.6%) were abnormal p53. Tumor-infiltrating lymphocyte (TIL) reported in 110 patients (85.3%) and tumor-infiltrating T cell lymphocyte found in 107 patients (82.9%). The rate of positive PD-L1 in high grade was 46.67% and low-grade EC was 28.78%. Non-endometrioid histology, deep myometrial invasion, FIGO staging, poorly-differentiated histology, pelvic lymph node metastasis, lymphovascular invasion and cervical involvement were bad prognosis to overall survival significantly. In poorly-differentiated tumor subgroup, overall survival was affected by pelvic lymph node metastasis significantly. In well-differentiated tumor, deep myometrial invasion affected on survival outcome.

Conclusion: The rate of PD-L1 in EC patient was approximately 25% and more expression found in high-grade EC. The PD-L1 expression, MMR protein deficiency, p53 abnormal and TIL might not be a prognostic biomarker but tumor differentiation was the best survival marker.

 Keywords: CA Endometrium; Corpus; Endometrial Carcinoma; Corpus Uteri; PD-L1; Immune Checked Point; Program Death Ligand 1

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