Programmed death ligand (PD-L1) expression in invasive squamous cell carcinoma of the uterine cervix: A cross-sectional observational study

ABSTRACT Background: Normal cervical epithelium does not express programmed death ligand-1 (PD-L1) protein. Expression of PD-L1 has been reported in 50% cells of cervical carcinoma. Approximately 17% of adenocarcinomas and 35% of squamous cell carcinomas (SCC) of the cervix express PD-L1. Objectives: To determine the expression of PD-L1 in invasive SCC of the cervix and to correlate the expression with various clinicopathological parameters. Materials and Methods: This was a cross-sectional study conducted between July 2016 and June 2021 in the Department of Pathology, in collaboration with the Department of Obstetrics and Gynecology at the R. L. Jalappa Hospital and Research Center, Kolar, in South India. proportion of PD-L1 expression was evaluated on the biopsy specimens by immunohistochemistry (PD-L1 Antibody Biogenex AN921-M) and based on the PD-L1 positive cells, was scored as 0 (<5%), 1 (5–29%), 2 (30–59%), and 3 (>60%). We evaluated the association of PD-L1 expression with the clinicopathological parameters. Results: We included 90 cases of SCC of the cervix. The median age was 52.5 years (range, 30–74), with the majority of patients between the ages of 40–49 years. Overall, PD-L1 expression was noted in 66.7% cases of SCC of the cervix. PD-L1 marker expression increased with age, from 40–49 years (n = 14/28, 50%) to 70–79 years (n = 10/12, 83.3%); P = 0.037. PD-L1 expression was maximum (n = 40/47, 85.1%) in moderately differentiated SCC; there was a significant correlation between histological grade and PD-L1 expression; P < 0.001. There were no significant correlations between the PD-L1 expression and other clinicopathological parameters such as parity, clinical findings, disease stage, size of lesion, lymph node status, and overall survival. Conclusion: Two-thirds of cervical SCC cases express PD-L1. The PD-L1 expression is significantly associated with the patient’s age and the grade of the disease. Evaluation of PD-L1 expression in SCC of the cervix is important as anti-PD-L1/PD-1 immunotherapies can be used in PD-L1 positive cervical cancer.