Page 178 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology PD-1/L1 inhibitors in advanced CC: Multicenter retro

of Zhengzhou University and Henan Cancer Hospital were Numberof positivetumorcells
collected. Cases within stages IB2 and IIA were not included numberof positiveimmunecells (I)
in the study due to their low numbers. The inclusion criteria CPS T Totalnumberoftumorcells 100
of this study are as follows: (i) pathologically confirmed
primary cervical squamous carcinoma or adenocarcinoma, The 2024 NCCN guidelines recommended
(ii) availability of complete case information (including immunotherapy for cervical cancer patients with a CPS
age at diagnosis, histological type, FIGO 2018 stage, ≥1. Consequently, in this study, CPS ≥1 was utilized to
treatment plan, pathological results, tumor diameter, designate PD-L1-positive cases.
PD-L1 expression, treatment modality after recurrence/
metastasis, and patient outcome), and (iii) availability of 2.4. Statistical analysis
complete follow-up information. The exclusion criteria The Statistical Package for the Social Sciences statistical
were incomplete clinical information and follow-up data. package (version 26.0, Chicago, United States) was used for
A total of 204 cases were collected, of which 12 cases were all statistical analyses. Continuous variables with normal
excluded due to incomplete records, and 192 cases that distribution were reported as mean ± standard deviation
met the screening criteria were included in the study. All and independent t-tests were employed for comparison.
patients received conventional chemotherapy + radical Categorical variables were presented as frequencies and
hysterectomy + radiotherapy as initial treatment. There percentages (n[%]), and comparisons between groups
were 180 cases of squamous cervical cancer and 12 cases of were made using the Chi-square test or Fisher’s exact
adenocarcinoma in which the size of the tumor diameter test. Kaplan-Meier curves were generated to assess
was measured using magnetic resonance imaging, and clinicopathologic variables and their associations with PFS
subgroups were analyzed on a threshold of 4 cm. Due to and OS. Hypothesis testing for the comparison of Kaplan-
factors such as patient preference, the choice of dosing Meier curves in the two groups was performed using the
regimen, and preference of the supervising physician, log-rank (Mantel-Cox) test. Screening for risk factors
91 patients received initial treatment with a PD-1/PD-L1 associated with PFS and OS was conducted using Cox
inhibitor as the treatment group, and the other 101 patients regression analysis. p≤0.05 were considered statistically
received therapy without a PD-1/PD-L1 inhibitor and were significant.
set up as the control group.
3. Results
2.2. Follow-up
3.1. Baseline characteristics of advanced cervical
After the primary treatments, these patients were routinely cancer patients
19
followed up as recommended by the NCCN guidelines.
In the 1 and 2 years, follow-up was conducted every As shown in Table 1 and Figure 1, our study examined
st
nd
3 months. Subsequently, follow-ups were performed every a total of 204 patients diagnosed with advanced cervical
half a year in the 3 and 4 years. In the 5 year and onward, cancer. Out of these, 12 patients were excluded from
th
th
rd
follow-ups were done once a year. The last follow-up was the analysis due to incomplete records. Thus, a total of
performed in May 2024. OS was defined as the interval 192 patients with advanced cervical cancer were evaluable
from the diagnosis of cervical cancer to the patient’s death. for the final analysis. They were divided into the treatment
PFS was defined as the duration from the initial diagnosis group (n=91) and the control group (n=101) according to
to the onset of the first tumor progression. whether PD-1/PD-L1 inhibitor therapy is included in the
first-line treatment.
2.3. Evaluation of PD-L1 expression
In the treatment group, the median age was 53 (ranging
Immunohistochemical staining was conducted to evaluate from 25 to 82 years old), and 93.4% had squamous cell
the expression of PD-L1 in cervical cancer tissues. The carcinoma (SCC). In contrast, the control group had
primary antibody was purchased from DAKO (Germany, a median age of 51 years old, with 94.1% having SCC.
clone number: 22-C3). An additional pathologist According to the FIGO 2018 staging criteria, 62 patients
validated the results. A combined positive score (CPS) in the treatment group were classified as stage IIIC, six
was used as an indicator to evaluate PD-L1 expression patients with stage IVA, and 23 patients with stage IVB. In
during immunotherapy. It encompasses both the PD-L1 the control group, 73, three, and 25 cases were identified as
expression on tumor and tumor-associated immune cells. stage IIIC, stage IVA, and stage IVB, respectively. In the two
The CPS was determined by calculating the number of groups, 51.7% (n=47) and 34.6% (n=35) of patients received
tumor cells and tumor-associated immune cells per 100 the test for PD-L1 expression (Table 1). The distribution of
tumor cells using the formula in Equation I: patients between the two groups was relatively balanced,

Volume 9 Issue 2 (2025) 170 doi:10.36922/ejmo.8074