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Abstract

Volume 24, Issue 5 (September 2022) 24, 525–532; 10.4103/aja202186

Immunohistochemical analysis of PD-L1 and tumor-infiltrating immune cells expression in the tumor microenvironment of primary signet ring cell carcinoma of the prostate

Qi-Liang Teng1, Xin-Rui Yang2, Shuang Wen3, Zhi-Hong Dai1, Hong-Long Wang3, Tian-Qing Liu3, Liang Wang1, Bo Fan1, Zhi-Yu Liu1

1 Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
2 Department of Clinical Imaging, Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
3 Department of Pathology, Dalian Friendship Hospital, Dalian 116001, China

Correspondence: Dr. ZY Liu (lzydoct@163.com) or Dr. B Fan (fanbo@dmu.edu.cn)

Date of Submission 01-Jul-2021 Date of Acceptance 15-Oct-2021 Date of Web Publication 14-Jan-2022

Abstract

Primary signet ring cell carcinoma (SRCC) of the prostate is a rare neoplasm. However, its potential tumorigenic mechanism, clinicopathological features, and prognostic outcome have not been systematically described. To determine the pathogenic mechanism, we detected distributions of programmed cell death-ligand 1 (PD-L1), programmed death 1 (PD-1), and cellular components in the tumor microenvironment, including tumor-infiltrating lymphocytes (CD4 and CD8), tumor-associated macrophages (TAMs; CD163 and CD68), and tumor-associated fibroblasts (vimentin and alpha-smooth muscle actin [α-SMA]), in tumor tissues from four patients with primary prostatic SRCC compared with corresponding adjacent tissues and tumor tissues from 30 patients with prostate adenocarcinoma (PCa) by immunohistochemical staining. We found higher expression of PD-L1, CD163, and CD68 in primary SRCC specimens than that in both corresponding adjacent nontumor specimens and PCa specimens with different Gleason scores, indicating that TAMs may participate in the malignant biological behavior of primary SRCC of the prostate. For further analysis, we searched electronic journal databases and Surveillance, Epidemiology, and End Results (SEER) to identify 200 eligible patients including our four cases. According to Kaplan–Meier survival curve analysis, patients <68 years old, with radical prostatectomy (RP), Gleason score of 7–8, and lower clinical stage had longer overall survival (OS). Moreover, Cox multivariate analysis indicated that race (hazard ratio [HR] = 1.422), surgical approach (HR = 1.654), and Gleason score (HR = 2.162) were independent prognostic factors for OS. Therefore, primary SRCC of the prostate represents a distinct and aggressive subtype of prostate cancer associated with a higher distribution of PD-L1 and TAMs, which warrants further clinical investigation.

Keywords: clinical features; immunohistochemistry; infiltrating immune cells; primary signet ring cell carcinoma of the prostate; tumor microenvironment

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