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Prognostic value of proliferation, PD-L1 and nuclear size in patients with superior sulcus tumours treated with chemoradiotherapy and surgery
  1. Hans Blaauwgeers1,
  2. Birgit I Lissenberg-Witte2,
  3. Chris Dickhoff3,
  4. Sylvia Duin4,
  5. Erik Thunnissen4
  1. 1Department of Pathology, OLVG LAB BV, Amsterdam, The Netherlands
  2. 2Department of Epidemiology and Data Science, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC - Cancer Center Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Pathology, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Hans Blaauwgeers, Department of Pathology, OLVG Locatie Oost, Amsterdam 1090 HM, The Netherlands; hansblaauwgeers{at}icloud.com

Abstract

Aims The aim of this study was to determine the relationship between proliferative activity, PD-L1 status and nuclear size changes after preoperative chemoradiotherapy (CRT) and the clinical outcome in patients with superior sulcus tumours.

Methods Proliferative activity (MIB-1) and PD-L1 status were estimated by immunohistochemistry in the tumour cells of resection specimen in a series of 33 patients with residual tumour after trimodality therapy for a sulcus superior tumour between 2005 and 2014. A morphometric analysis of both pretreatment and post-treatment tumour materials was also performed. Results were related to disease-free survival and overall survival.

Results Low proliferative activity (<20% MIB-1) was associated with better overall survival: 2-year overall survival of 73% compared with 43% and 25%, respectively, for moderate (MIB-1 20%–50%) and high (MIB-1 >50%) proliferative activity (p=0.016). A negative PD-L1 status (<1% positive tumour cells) was also associated with better overall survival (p=0.021). The mean nuclear size of normal lung tissue pneumocytes was significantly smaller compared with the mean nuclear size of tumour cells of the resection specimens (median difference −38.1; range −115.2 to 16.0; p<0.001). The mean nuclear size of tumour cells did not differ between pretreatment biopsies and resection specimens (median difference −4.6; range −75.2 to 86.7; p=0.14). Nuclear size was not associated with survival (p=0.82).

Conclusions Low proliferative activity determined by MIB-1 as well as a negative PD-L1 expression are significantly associated with better overall survival in patients with residual tumour after CRT for superior sulcus tumour.

  • lung cancer
  • morphometry
  • proliferating cell nuclear antigen
  • immunohistochemistry

Data availability statement

Data are available upon reasonable request. Data from all scored item and measurements are available, but at a single case level not relevant to (supplementary) include in the manuscript.

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Data availability statement

Data are available upon reasonable request. Data from all scored item and measurements are available, but at a single case level not relevant to (supplementary) include in the manuscript.

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Footnotes

  • Handling editor Runjan Chetty.

  • Contributors All authors have contributed significantly to the manuscript, either to statistical analyses, retrieving clinical data, performing immunohistochemical staining, or writing and rewriting the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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