PD-L1 Expression in Endometrial Serous Carcinoma and Its Prognostic Significance

Figures & data

Table 1 PD-L1 Expression in Relation to Clinicopathological Parameters

Variable	Category	TPS (n)		p-value	CPS (n)		p-value
		<1%	≥1%		<1	≥1
Age (years)	≤ 63	19	23	0.025^†	9	33	0.252
	> 63	26	11		12	25
BMI (kg/m^2)	< 25	26	22	0.532	11	37	0.359
	≥ 25	19	12		10	21
CA125 (U/mL)	≤ 35	35	25	0.662	15	45	0.572
	> 35	10	9		6	13
Histotype	Pure	26	19	0.866	14	31	0.295
	Mixed	19	15		7	27
Stage	I	27	11	0.015^†	12	26	0.333
	II–IV	18	23		9	32
MI	< 50%	36	15	0.001^†	18	33	0.018^†
	≥ 50%	9	19		3	25
LNM	Negative	40	23	0.060	17	37	0.529
	Positive	6	10		3	13
LVSI	Negative	40	20	0.002^†	18	42	0.222
	Positive	5	14		3	16
Surgery	RD ≤ 1cm	43	29	0.133	19	53	1.000
	RD > 1cm	2	5		2	5
Ascites	Negative	42	27	0.090	19	50	1.000
	Positive	3	7		2	8

Note: ^†p< 0.05, Chi-square or Fisher’s exact test was used.

Abbreviations: PD-L1, Programmed death-ligand 1; TPS, tumor proportion score; CPS, combined positive score; MI, Myometrial invasion; LNM, Lymph node metastasis; LVSI, Lymphovascular space invasion; RD, residual disease.

Figure 1 PD-L1 expression in endometrial serous carcinoma. (A–C) Representative area of endometrial serous carcinoma at medium power (H&E, 200x); (D) Corresponding negative PD-L1 expression;(E) Corresponding PD-L1 expression in tumor cells; (F) Corresponding PD-L1 expression in immune cells.

Table 2 Univariate and Multivariate Analysis of the Clinicopathologic Parameters and OS

Variable	Univariate		Multivariate (Enter/[Forward] Selection)
	HR	p-value	HR	CI	p-value
Age (≤ 63 vs > 63 years)	1.038	0.919	-	-	-
BMI (< 25 vs ≥ 25 kg/m^2)	0.877	0.731	-	-	-
CA125 (≤ 35 vs > 35 U/mL)	2.458	0.019^†	1.313	0.541–3.185	0.547
Histotype (Pure vs Mixed)	1.082	0.833	-	-	-
Stage (I vs II–IV)	5.276	<0.001^†	3.813	1.427–10.189	0.008^†
			[4.491	1.795–11.235	0.001^†]
MI (< 50% vs ≥50%)	2.925	0.004^†	1.971	0.846–4.593	0.116
			[2.192	1.040–4.616	0.039^†]
LNM (Absent vs Present)	1.734	0.206	-	-	-
LVSI (Absent vs Present)	2.319	0.032^†	1.073	0.423–2.718	0.882
RD (≤ 1 vs > 1 cm)	2.432	0.099	-	-	-
Ascites (Absent vs Present)	2.661	0.034^†	1.189	0.404–3.499	0.754
TPS of PD-L1 (Negative vs Positive)	2.132	0.043^†	1.229	0.531–2.843	0.631
CPS of PD-L1 (Negative vs Positive)	1.167	0.722	-	-	-

Note: ^†p< 0.05, Cox regression was used for multivariate analysis, with enter and forward selection.

Abbreviations: BMI, body mass index; MI, myometrial invasion; LNM, lymph node metastasis; LVSI, lymphovascular space invasion; RD, residual disease; TPS, tumor proportion score; CPS, combined positive score; HR, hazard ratio; CI, confidence interval.

Table 3 Univariate and Multivariate Analysis of the Clinicopathologic Parameters and PFS

Variable	Univariate		Multivariate (Enter/[Forward] Selection)
	HR	p-value	HR	CI	p-value
Age (≤ 63 vs > 63 years)	0.724	0.297	-	-	-
BMI (< 25 vs ≥ 25 kg/m^2)	0.859	0.630	-	-	-
CA125 (≤ 35 vs > 35 U/mL)	2.312	0.009^†	1.459	0.684–3.112	0.328
Histotype (Pure vs Mixed)	1.000	1.000	-	-	-
Stage (I vs II–IV)	3.139	<0.001^†	2.637	1.206–5.767	0.015^†
			[2.724	1.411–5.261	0.003^†]
MI (< 50% vs ≥50%)	2.046	0.019^†	1.757	0.824–3.747	0.145
LNM (Absent vs Present)	2.134	0.032^†	0.593	0.200–1.757	0.346
LVSI (Absent vs Present)	2.149	0.019^†	1.272	0.518–3.120	0.599
RD (≤ 1 vs > 1 cm)	2.888	0.017^†	0.580	0.178–1.895	0.367
Ascites (Absent vs Present)	3.361	0.002^†	2.879	0.992–8.355	0.052
TPS of PD-L1 (Negative vs Positive)	2.380	0.005^†	2.433	0.986–6.005	0.054
			[1.921	1.035–3.566	0.039^†]
CPS of PD-L1 (Negative vs Positive)	0.969	0.929	-	-	-

Note: ^†p< 0.05, Cox regression was used for multivariate analysis, with enter and forward selection model.

Abbreviations: BMI, body mass index; MI, myometrial invasion; LNM, lymph node metastasis; LVSI, lymphovascular space invasion; RD, residual disease; TPS, tumor proportion score; CPS, combined positive score; HR, hazard ratio; CI, confidence interval.

Figure 2 Kaplan–Meier curves of overall survival (OS) and progression-free survival (PFS) in patients with endometrial serous carcinoma (ESC). (A) OS in PD-L1-negative group (green) and PD-L1-positive group (blue) using tumor proportion score (TPS) (cut off 1%). (B) OS in PD-L1-negative group (green) and PD-L1-positive group (blue) using combined positive score (CPS) (cut off 1). (C) PFS in PD-L1-negative group (green) and PD-L1-positive group (blue) using TPS (cut off 1%). (D) PFS in patients in PD-L1-negative group (green) and PD-L1-positive group (blue) using CPS (cut off 1).