Prevalence and prognostic value of PD-L1 expression and tumor mutational burden in persistent, recurrent, or metastatic cervical cancer

초록

Objective: To evaluate the prevalence and prognostic role of programmed death ligand 1(PD- L1) expression and tumor mutational burden (TMB) in patients with non-immunotherapytreated advanced cervical cancer. Methods: Clinical data were retrospectively collected from medical records between January 1, 2008, and December 31, 2016, at Asan Medical Center (Korea); archived tumor samples were assessed for PD-L1 expression (combined positive score [CPS] >= 1) and TMB (>= 175 mutations/exome). Overall survival (OS) was defined as time from advanced diagnosis or initiation of first-line or second-line systemic therapy until death/last follow-up. The association of OS with PD-L1 expression and TMB were analyzed using the log-rank test and Cox proportional hazards model adjusted for covariates. Results: Of 267 patients, 76.0% had squamous cell carcinoma (SCC), 24.0% had adenocarcinoma (AC)/adenosquamous carcinoma (ASC), 64.4% had PD-L1 CPS >= 1, and 32.6% had TMB >= 175 mutations/exome. PD-L1 CPS >= 1 and TMB >= 175 mutations/exome were more prevalent in SCC than in AC/ASC (73.9% and 37.2% vs. 34.4% and 17.7%). There was no association between OS and PD-L1 expression (CPS >= 1 vs. <1: adjusted hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.84-1.53 from advanced diagnosis); OS trended shorter for the subgroup with TMB >= 175 versus <175 mutations/exome (adjusted HR=1.29; 95% CI=0.95-1.75). Conclusion: Retrospective analysis of non-immunotherapy-treated patients with advanced cervical cancer demonstrated a higher prevalence of PD-L1 CPS >= 1 and TMB >= 175 mutations/ exome in SCC versus AC/ASC. PD-L1 CPS >= 1 was not associated with OS; TMB >= 175 mutations/exome showed a trend toward shorter OS. Additional studies are needed to confirm these findings.

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