Page 56 - JCTR-9-4

Journal of Clinical and Translational Research 2023; 9(4): 272-281

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

ORIGINAL ARTICLE

PD-L1 expression and prognosis in definitive radiotherapy patients with

neuroendocrine cervical carcinoma

Huiling Li *, Xiuhua Li , Meichun Yang , Huiyan Su , Jianqiu Zhang , Chunmiao Hu , Yingming Sun , Dan Hu , Li Chen 5
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1 Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China, Department
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of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China, Department of Radiotherapy,
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Affiliated Sanming First Hospital, Fujian Medical University, Sanming, Fujian, China, Department of Pathology, Clinical Oncology School of Fujian
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Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China, School of Arts and Sciences, Fujian Medical University, Fuzhou, Fujian, China
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ARTICLE INFO ABSTRACT
Article history: Background: Neuroendocrine carcinoma of the cervix (NECC) is more prone to lymphatic
Received: May 15, 2023 infiltration, lymph node involvement, local recurrence, and distant metastasis. Using concurrent
Revised: June 10, 2023 chemoradiotherapy (CCRT) with or without adjuvant chemotherapy as the standard treatment for
Accepted: July 11, 2023 locally advanced NECCs and CCRT for patients with early lesions confined to the cervix. However,
Published online: July 28, 2023 the prognosis of NECC patients treated with definitive radiotherapy (RT) is unknown. Immune
checkpoint inhibitors are a promising therapeutic strategy for locally advanced cervical cancer. Some
Keywords: reports suggest that the expression of PD-L1 in solid tumors correlates with prognosis.
Cervical carcinoma Aim: This study investigates prognostic factors for survival in patients with neuroendocrine cervical
Neuroendocrine carcinoma carcinoma (NECC) treated with definitive RT and the relationship between PD-L1 expression and
Small-cell neuroendocrine carcinoma prognosis in these patients.
Chemotherapy Methods: This retrospective study included 66 patients with histologically confirmed NECC who
Chemoradiotherapy received RT with or without chemotherapy. From January 2015 to December 2020, patients received
routine extended-field irradiation (EFI), and PD-L1 expression was assessed by immunohistochemistry.
*Corresponding authors: The most commonly used chemotherapy agents were etoposide-platinum and paclitaxel-platinum.
Huiling Li Results: PD-L1 expression was positive in 17 of 45 (37.8%) patients. There were 52 cases of pure NECC
Department of Gynecology, Clinical Oncology and 14 cases of mixed carcinoma. Sixty stage IB-III patients received definitive RT. The 3- and 5-year
School of Fujian Medical University, Fujian progression-free survival (PFS) was 39.8% and 34.1%, and 3- and 5-year overall survival (OS) was 48.0%
Cancer Hospital, Fuzhou, Fujian, China. and 40.2%, respectively. There was no significant difference in 3 and 5-year PFS and 3 and 5-year OS
E-mail: huilin888999@126.com between patients with pure and mixed carcinoma. Positive PD-L1 expression was associated with higher
3-year PFS in patients with mixed histology. Univariate analysis showed that lymph node metastasis
© 2023 Author(s). This is an Open-Access (LNM) and the International Federation of Gynecology and Obstetrics stages predicted 3- and 5-year PFS
article distributed under the terms of the in patients who received definitive RT. The median OS in patients receiving less than four cycles and at
Creative Commons Attribution-Noncommercial least four cycles of chemotherapy (CT) was 26.0 and 44.0 months, respectively (P = 0.038); moreover,
License, permitting all non-commercial use,
distribution, and reproduction in any medium, 3- and 5-year PFS was 34.1% and 25.7% in the former and 46.4% and 40.4% in the latter. There were
provided the original work is properly cited. no significant differences in OS and PFS between pelvic irradiation and prophylactic EFI in patients
treated with definitive RT. There were no significant differences in para-aortic failure rate after concurrent
chemoradiotherapy between patients who underwent pelvic irradiation or prophylactic EFI (P = 0.147).
Conclusion: In patients with mixed NECC, positive PD-L1 expression is correlated with higher 3-year
PFS. Chemoradiotherapy was effective for NECCs. The LNM and stage predicted PFS. Four or more
cycles of chemotherapy improve prognosis. Prophylactic EFI did not significantly improve PFS and OS.
Relevance for Patients: This study is relevant to patients as it confirms that chemoradiotherapy is effective
for both early and locally advanced NECC and that four or more cycles of chemotherapy improved
prognosis. The regimen should be carefully evaluated to ensure that patients receive the most effective
radiation therapy for the prophylactic of para-aortic LNM. Potential risk factors for the recurrence of
radical radiotherapy should be fully understood to minimize these risks. This study observed that PD-L1
expression positive in patients with mixed NECC types is correlated with higher 3-year PFS.
DOI: http://dx.doi.org/10.18053/jctres.09.202304.23-00067