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Published on: August 9, 2019
Programmed death-ligand 1 expression in surgically resected thymomas
Luca Frasca1,2, Antonio Sarubbi1, Filippo Longo1
1Department of Thoracic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo 200, 00128, Rome, Italy.
Abstract:
Thymomas are one of the most common neoplasms of the anterior mediastinum with limited therapeutic options, particularly in advanced stages. The molecular profiles of these tumors remain poorly investigated. This study aims to evaluate the expression of programmed death ligand 1 (PD-L1) in a selected cohort of intentionally curative resected thymomas and evaluate a possible relationship with the risk of recurrence. This retrospective bicentric study analyzed a group of patients who underwent complete thymectomy with curative intent. PD-L1 expression was assessed through immunohistochemistry using the Ventana PD-L1 assay. PD-L1 expression was assessed as low if <50% or high when ≥50%. The Kaplan-Meier method and Cox regression analysis were performed to evaluate a possible relationship between PD-L1 expression and disease-free survival. High PD-L1 expression was observed in 46.2% of patients. Overexpression of this protein was significantly associated with aggressive (B2/B3) thymomas histotypes (p<0.001). During follow-up period, 12/52 patients developed recurrence. High PD-L1 expression correlated with reduced disease-free survival with Kaplan-Meier method (p<0.001). Furthermore, PD-L1 expression more than 50% resulted to be related to a worse prognosis at multivariable Cox regression analysis (hazard ratio 5.4, 95% confidence interval 1.5-16.9, p=0.028) together with histology (p=0.044) and Masaoka-Koga stage (p=0.026). The elevated expression of PD-L1, particularly in aggressive thymoma subtypes, underscores its potential as a prognostic biomarker. These findings support the need for further research to explore the potential of immunotherapy in treating these rare malignancies.
Insights
High programmed death ligand 1 (PD-L1) expression in thymomas is linked to increased recurrence risk. This finding suggests PD-L1 may serve as a prognostic biomarker for aggressive thymoma subtypes.
Area of Science:
- Oncology
- Immunology
- Pathology
Background:
- Thymomas, common anterior mediastinum neoplasms, have limited treatment options for advanced stages.
- The molecular characteristics of thymomas are not well understood.
- Investigating biomarkers is crucial for improving patient outcomes.
Purpose of the Study:
- To assess programmed death ligand 1 (PD-L1) expression in resected thymomas.
- To determine the relationship between PD-L1 expression and the risk of thymoma recurrence.
- To explore PD-L1 as a potential prognostic biomarker in thymoma.
Main Methods:
- Retrospective analysis of patients undergoing complete thymectomy for thymoma.
- Immunohistochemistry using the Ventana PD-L1 assay to quantify PD-L1 expression (<50% low, ≥50% high).
- Kaplan-Meier and Cox regression analyses to correlate PD-L1 expression with disease-free survival.
Main Results:
- High PD-L1 expression (≥50%) was found in 46.2% of patients.
- Elevated PD-L1 expression significantly correlated with aggressive thymoma histotypes (B2/B3).
- High PD-L1 expression was associated with reduced disease-free survival and worse prognosis (HR 5.4, p=0.028), alongside histology and Masaoka-Koga stage.
Conclusions:
- Elevated PD-L1 expression, especially in aggressive thymomas, indicates its potential as a prognostic biomarker.
- These results highlight the need for further investigation into immunotherapy for thymoma treatment.
- PD-L1 status may guide therapeutic strategies for thymoma patients.
