Characterization of the immune microenvironment in malignant pleural mesothelioma reveals prognostic subgroups of patients. (December 2020)

• Record Type: Journal Article
• Authors: Fusco, Nicola; Vaira, Valentina; Righi, Ilaria; Sajjadi, Elham; Venetis, Konstantinos; Lopez, Gianluca; Cattaneo, Margherita; Castellani, Massimo; Rosso, Lorenzo; Nosotti, Mario; Clerici, Mario; Ferrero, Stefano
• Is Part Of: Lung cancer. Volume 150(2020)
• Page Start: 53
• Page End: 61
• Publication Date: 2020-12
• Subjects: Mesothelioma -- Tumor immune microenvironment -- TILs -- PD-L1 -- Immunohistochemistry -- Prognosis; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.09.026
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: MPM expressing PD-L1 on tumor cells show increased stromal CD4 and CD19 cells, regardless of the MPM histology. Presence and relative proportion of lymphocytes within the stroma or at the periphery of the neoplastic nests has distinct clinical implications. While in PD-L1 negative cases sTILs have no prognostic role, in PD-L1 positive MPMs, CD4 T-cells are associated with a poorer outcome, particularly when in the presence of CD19-TILs. Stromal CD8-TILs are associated with a better outcome. Chemo-treated patients who lived longer had a higher percentage of stromal CD8 lymphocytes, particularly in PD-L1 negative MPMs. Abstract: Malignant pleural mesothelioma (MPM) is a rare tumor with an extremely poor prognosis. Its pathogenesis is related to an immune response against asbestos fibers. The T-lymphocytes, including CD8 POS and CD4 POS cells, are an important part of the MPM immune microenvironment, and likely contribute to the therapy resistance observed in these tumors. Here, we sought to characterize the MPM-specific lymphocytes subpopulations within the tumor immune microenvironment to identify novel clinically relevant immunologic subtypes of tumors. Representative formalin-fixed, paraffin-embedded (FFPE) tissue blocks of 88 MPMs were included in tissue microarrays and subjected to tumor-infiltrating lymphocytes (TILs) quantification and subtyping by immunohistochemistry (IHC) with antibodies specific for CD4, CD8, and CD19. Further, PD-L1 (clone 22C3) expression was assessed by IHC as a combined positive score (CPS). Our data show that PD-L1 expression by tumor cells or the presence of a sarcomatoid component is related to increased stromal TILs presence in MPM. Survival analyses showed that low CD4 POS and high CD8 POS stromal TILs are associated with poor patients' survival. In MPMs with PD-L1 CPS > 1, stromal CD8 HIGH was a poor prognostic factor, akin stromal CD4 POS peritumoral TILs correlated with a worse prognosis. Furthermore, we demonstrated that a high CD4 POS /CD8 POS ratio in the tumor immune microenvironment is an independent prognostic factor for survival. Finally, we provided evidence that the characterization of the stromal immune landscape of MPM predicts responses to chemotherapy in subgroups of MPM. The results of this study provide novel insights into the clinical scenario of immune-related biomarkers in MPM.