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The Relationship Between Mismatch Repair Deficiency and PD-L1 Expression in Breast Carcinoma.

乳腺癌中错配修复缺陷与PD-L1(程序性死亡受体-配体1)表达的关系。

Mills AM,Dill EA,Moskaluk CA,Dziegielewski J,Bullock TN,Dillon PM

Abstract

Mismatch repair (MMR) deficiency in solid tumors has recently been linked to susceptibility to immunotherapies targeting the programmed cell death-1 (PD-1)/programmed cell death-1 ligand (PD-L1) axis. Loss of MMR proteins has been shown to correlate with tumoral PD-L1 expression in colorectal and endometrial carcinomas, but the association between expression of MMR proteins and PD-L1 has not previously been studied in breast carcinoma, where MMR deficiency is less common. We assessed the relationship between PD-L1 and MMR protein expression by immunohistochemistry in 245 primary and 40 metastatic breast carcinomas. Tumoral staining for PD-L1 was positive in 12% of all cases, including 32% of triple-negative cancers. MMR deficiency was observed in 0.04% of breast cancers; the single MMR-deficient case was a high-grade, triple-negative ductal carcinoma which showed dual loss of MLH1 and PMS2 proteins and expressed PD-L1. Two ER carcinomas initially were scored with MMR protein loss in tissue microarray format but were subsequently shown to be MMR-intact on whole sections. Analysis of MMR gene mutation in The Cancer Genome Atlas corroborates low frequency of MMR deficiency for invasive breast cancer. MMR protein expression is therefore unlikely to show utility as a screen for immunotherapeutic vulnerability in this tumor type, and may provoke unwarranted genetic testing in patients unlikely to have a heritable cancer syndrome. PD-L1 may be a more clinically relevant biomarker for anti-PD-1/PD-L1 therapies in this setting.

摘要

最近发现实体瘤中的错配修复(MMR)缺陷与靶向程序性死亡受体1/程序性死亡受体-配体1信号通路免疫疗法的易感性相关。实验显示在结直肠癌及子宫内膜癌中MMR蛋白的缺失与肿瘤的PD-L1表达相关,但此前MMR蛋白的表达与PD-L1表达之间的关联未在MMR缺陷较少见的乳腺癌中进行研究。我们通过免疫组织化学方法评估了245例原发性和40例转移性乳腺癌中PD-L1与MMR蛋白表达之间的关系。所有病例中(包括32%三阴乳腺癌)有12%病例肿瘤的PD-L1免疫组化为阳性。0.04%的乳腺癌病例中观察到MMR缺陷,唯一一个MMR缺陷的病例是高级别三阴导管癌,其表现出MLH1及PMS2蛋白的双重丢失及PD-L1的表达。两个ER(原文缺失)癌最初在组织微阵列中进行了MMR蛋白质缺陷评分,但随后显示在整个切片上完整无损。分析癌基因组图谱中的MMR基因突变证实了侵袭性乳腺癌MMR缺陷出现的低频率。因此MMR蛋白表达不太可能在这种肿瘤类型中显示出用作免疫治疗易感性的筛选标志的效用,并且可能引起对不太可能具有遗传性癌症综合征的患者进行无意义的基因检测。在这种情况下,PD-L1可能是抗PD-1/PD-L1治疗更具临床相关性的生物标志物。

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