Abstract
Sinonasal squamous cell carcinoma (SNSCC) is an aggressive tumor predominantly arising in the maxillary sinus and nasal cavities. Advances in imaging, surgical and radiotherapeutic techniques have reduced complications and morbidity; however, the prognosis generally remains poor, with an overall 5-year survival rate of 30–50%. As immunotherapy may be a new therapeutic option, we analyzed CD8+ tumor-infiltrating lymphocytes (TILs) and the tumor microenvironment immune type (TMIT, combining CD8+ TILs and PD-L1) in a series of 57 SNSCCs. Using immunohistochemistry, tissue samples of 57 SNSCCs were analyzed for expression of CD8 on TILs and of PD-L1 on tumor cells. The results were correlated to the clinical and survival data. In total, 88% (50/57) of the tumors had intratumoral CD8+ TILs; 19% (11/57)—CD8high (>10%); and 39/57 (68%)—CD8low (1–10%). PD-L1 positivity (>5%) was observed in 46% (26/57) of the SNSCCs and significantly co-occurred with CD8+ TILs (p = 0.000). Using univariate analysis, high intratumoral CD8+ TILs and TMIT I (CD8high/PD-L1pos) correlated with a worse survival rate. These results indicate that SNSCCs are immunogenic tumors, similar to head and neck squamous cell carcinomas. Nineteen percent of the cases were both CD8high and PD-L1pos and this subgroup may benefit from therapy with immune checkpoint inhibitors.
Highlights
Malignant tumors of the sinonasal cavity are rare, accounting for less than 5% of all head and neck cancers [1]
Sinonasal squamous cell carcinoma (SNSCC) is the most common subtype of epithelial tumors of the sinonasal cavity which predominantly occurs in the maxillary sinus and the nasal cavity and accounts for 50–80% of all sinonasal malignances, with the highest incidences reported in European countries [2]
The presence of CD8+ tumor-infiltrating lymphocytes (TILs) has been associated with favorable clinical outcomes in patients with head and neck squamous cell carcinomas (HNSCC) [15,16,17,18,19,20,21] and in sinonasal tumors including SNSCCs, intestinal type adenocarcinomas (ITAC) and olfactory neuroblastomas (ONB) [15,22,23]
Summary
Malignant tumors of the sinonasal cavity are rare, accounting for less than 5% of all head and neck cancers [1]. The presence of CD8+ TILs has been associated with favorable clinical outcomes in patients with HNSCCs [15,16,17,18,19,20,21] and in sinonasal tumors including SNSCCs, intestinal type adenocarcinomas (ITAC) and olfactory neuroblastomas (ONB) [15,22,23]. The clinical relevance of this classification is supported by its correlation with high mutational burden and oncogenic viral infection [25] and may predict the response to immunotherapy on an individual basis [26,27,28]. The results were correlated with the clinical and survival data
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