Abstract
BackgroundAdrenocortical carcinoma (ACC) is a rare tumor in which prognostic factors are still not well established. Programmed Death Ligand-1 (PD-L1) expression in ACC and its association with clinico-pathological features and survival outcomes are unknown.MethodsFormalin-fixed paraffin-embedded (FFPE) specimens were obtained from 28 patients with ACC. PD-L1 expression was evaluated by immunohistochemistry (IHC) in both tumor cell membrane and tumor infiltrating mononuclear cells (TIMC). PD-L1 positivity on tumor cells was defined as ≥5% tumor cell membrane staining. TIMC were evaluated by IHC using a CD45 monoclonal antibody. For PD-L1 expression in TIMC, a combined score based on the extent of infiltrates and percentage of positive cells was developed. Any score greater that zero was considered PD-L1 positive. Baseline clinico-pathological characteristics and follow up data were retrospectively collected. Comparisons between PD-L1 expression and clinico-pathological features were evaluated using unpaired t-test and Fisher’s exact test. Kaplan-Meier method and log-rank test were used to assess association between PD-L1 expression and 5-year overall survival (OS).ResultsAmong 28 patients with surgically treated ACC, 3 (10.7%) were considered PD-L1 positive on tumor cell membrane. On the other hand, PD-L1 expression in TIMC was performed in 27 specimens and PD-L1 positive staining was observed in 19 (70.4%) patients. PD-L1 positivity in either tumor cell membrane or TIMC was not significantly associated with higher stage at diagnosis, higher tumor grade, excessive hormone secretion, or OS.ConclusionsPD-L1 expression can exist in ACC in both tumor cell membrane and TIMC with no relationship to clinico-pathologic parameters or survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s40425-015-0047-3) contains supplementary material, which is available to authorized users.
Highlights
Adrenocortical carcinoma (ACC) is a rare tumor in which prognostic factors are still not well established
Patients and tumor characteristics A total of 28 patients with ACC were included in this study
The stage at diagnosis was defined pathologically according to International Union Against Cancer (UICC) and European Network for the Study of Adrenal Tumors (ENSAT) staging systems [23]
Summary
Adrenocortical carcinoma (ACC) is a rare tumor in which prognostic factors are still not well established. Adrenocortical carcinoma (ACC) is a rare and highly lethal malignancy arising from the adrenal cortex. ACC carries a poor prognosis with the most consistent prognostic factor being tumor stage at the time of diagnosis [3]. Retrospective studies have reported a 5year survival rate of 24% for stage III and 0% for stage IV disease [4]. Complete surgical resection remains the only chance of cure for patients with early-stage disease (stage I and II). Resection is the mainstay of therapy, even for patients with locally advanced disease. Despite aggressive management, close to 80% of surgically treated patients will develop subsequent metastatic disease [6]
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