PD-L1 expression patterns in oral cancer as an integrated approach for further prognostic classification

Marisol Miranda-Galvis, Alicia Rumayor Piña, Raísa Sales de Sá, Amanda Almeida Leite, Pablo Agustin Vargas, Vinicius Fernando Calsavara, Clóvis A. Lópes Pinto, Yong Teng, Luiz Paulo Kowalski

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Despite the well-known role of programmed cell death ligand 1 (PD-L1) in promoting immune resistance in oral squamous cell carcinoma (OSCC), its potential utility as a prognostic biomarker is undetermined. We evaluated PD-L1 expression as predictor of survival in patients with OSCC and explored PD-L1 expression patterns. Methods: We conducted a retrospective cohort study that assessed PD-L1 expression through immunohistochemistry in 123 surgical specimens of OSCC. A first approach evaluated tumor proportion scores (TPS) and combined proportion scores (CPS). Next, expression patterns were examined by evaluating PD-L1 localization in tumor nests, as well as the interfaces of tumor cells (TC) and immune cells (IC) in the tumor microenvironment. Results: High-level PD-L1 expression determined by TPS and CPS using variable cutoffs was not associated with survival. Immunohistochemistry revealed that TC expressed PD-L1 in either patchy or diffuse patterns. The patchy pattern was an independent risk factor for overall survival. Furthermore, expression patterns in the tumor immune microenvironment showed that most cases expressed PD-L1 on both TC and IC, while PD-L1 non-expressors had the lowest overall survival. Conclusion: PD-L1 expression patterns in the context of localization in tumor nests and TC—IC interactions represent antitumor immune responses better than either TPS or CPS. Our suggested classification system may have important implications for the characterization of OSCC and for the use of PD-L1 as a prognostic biomarker.

Original languageEnglish (US)
Pages (from-to)1699-1710
Number of pages12
JournalOral Diseases
Issue number7
StatePublished - Oct 2021


  • expression pattern
  • immune microenvironment
  • oral cancer
  • programmed cell death ligand 1
  • score

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Dentistry(all)


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