Cancer Res Treat.  2024 Apr;56(2):557-566. 10.4143/crt.2023.1025.

PD-L1 (SP142) Expression in Primary and Recurrent/Metastatic Triple-Negative Breast Cancers and Its Clinicopathological Significance

• Han EK
• Woo JW
• Suh KJ
• Kim SH
• Kim JH
• Park SY

• KMID: 2554345
• DOI: http://doi.org/10.4143/crt.2023.1025

Abstract

Purpose
The programmed death-ligand 1 (PD-L1) SP142 assay identifies patients with triple-negative breast cancer (TNBC) who are most likely to respond to the anti–PD-L1 agent atezolizumab. We aimed to compare PD-L1 (SP142) expression between primary and recurrent/metastatic TNBCs and elucidate the clinicopathological features associated with its expression.
Materials and Methods
Primary and recurrent/metastatic TNBCs tested with PD-L1 (SP142) were collected, and clinicopathological information of these cases was obtained through a review of slides and medical records.
Results
PD-L1 (SP142) positivity was observed in 50.9% (144/283) of primary tumors and 37.8% (31/82) of recurrent/metastatic TNBCs with a significant difference. Recurrent or metastatic sites were associated with PD-L1 positivity, with high PD-L1 positivity in the lung, breast, and soft tissues, and low positivity in the bone, skin, liver, and brain. When comparing PD-L1 expression between primary and matched recurrent/metastatic TNBCs using 55 paired samples, 20 cases (36.4%) showed discordance; 10 cases revealed positive conversion, and another 10 cases revealed negative conversion during metastatic progression. In primary TNBCs, PD-L1 expression was associated with a higher histologic grade, lower T category, pushing border, and higher tumor-infiltrating lymphocyte infiltration. In survival analyses, PD-L1 positivity, especially high positivity, was found to be associated with favorable prognosis of patients.
Conclusion
PD-L1 (SP142) expression was lower in recurrent/metastatic TNBCs, and substantial cases showed discordance in its expression between primary and recurrent/metastatic sites, suggesting that multiple sites may need to be tested for PD-L1 (SP142) when considering atezolizumab therapy. PD-L1 (SP142)–positive TNBCs seems to be associated with favorable clinical outcomes.

Keyword

PD-L1; SP142; Tripe negative breast neoplasms; Discordance; Metastasis

Figure

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  Fig. 1. Comparison of programmed death-ligand 1 (PD-L1) (SP142) expression between primary and recurrent/metastatic triple-negative breast cancers. Of a total of 365 cases, 175 (47.9%) were positive for PD-L1 (SP142). Among the 283 primary tumors, 144 (50.9%) were PD-L1–positive, whereas four of the seven recurrent tumors (57.1%) and 27 of the 75 metastatic tumors (36.0%) were PD-L1–positive.

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  Fig. 2. Representative cases of positive and negative conversion of programmed death-ligand 1 (PD-L1) (SP142) expression in the metastatic sites. (A, B) A case with negative conversion. Primary tumor (A) shows PD-L1 positivity, while metastatic tumor to the skin (B) shows PD-L1 negativity. (C, D) A case showing positive conversion. Primary tumor (C) is negative for PD-L1 and metastatic tumor in the chest wall (D) is positive for PD-L1.

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  Fig. 3. Kaplan-Meier survival curve for recurrence-free survival according to programmed death-ligand 1 (PD-L1) (SP142) status. (A) Kaplan-Meier survival curve shows increased survival time in the PD-L1–positive group compared to PD-L1–negative group (p=0.049 by log-rank test). (B) PD-L1 high tumors show better survival compared to non–PD-L1 high tumors (p=0.005 by log-rank test).

Reference

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