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EP200/#131  Invasive stratified mucin-producing carcinoma of the uterine cervix: comparison of ITS clinicopathological characteristics and programmed death-ligand 1 expression status with other endocervical adenocarcinomas
  1. Jiyeon Lee1,
  2. Sangjoon Choi2 and
  3. Hyun-Soo Kim3
  1. 1Guro Hospital, Korea University College of Medicine, Department of Pathology, Seoul, Korea, Republic of
  2. 2Asan Medical Center, Department of Pathology, Seoul, Korea, Republic of
  3. 3Samsung Medical Center, Department of Pathology and Translational Genomics, Seoul, Korea, Republic of


Introduction Invasive stratified mucin-producing carcinoma (ISMC) is a rare histological type of human papillomavirus-associated (HPVA) mucinous-type endocervical adenocarcinoma (EAC). Compared to other HPVA EACs, ISMC shows more frequent post-treatment recurrences and metastases as well as worse survival. We investigated the differences in clinicopathological characteristics, patient outcomes, and programmed death-ligand 1 (PD-L1) expression status among ISMC, usual-type EAC (UEA), and gastric-type EAC (GEA).

Methods PD-L1 22C3 immunostaining was performed using 20 ISMCs, 20 UEAs, and 20 GEAs. PD-L1 expression was assessed using combined positive score (CPS). We examined whether there are significant differences in clinicopathological characteristics and PD-L1 expression status among ISMC, UEA, and GEA.

Results ISMC showed significantly younger age, more advanced stage, and shorter survival than UEA. Recurrence-free and overall survival rates of ISMC patients were comparable to those of GEA and significantly lower than those of UEA. All 20 ISMCs showed PD-L1 over-expression with a mean CPS of 43.5 (range=10–100), which was significantly higher than that of UEA (mean CPS=8.2; p=0.017) and GEA (mean CPS=6.5; p=0.004). In spite of PD-L1 over-expression, ISMC patients who treated with pembrolizumab showed no clinical responses. PD-L1 overexpression was found to be a significant predictor for RFS and OS in patients with ISMC. All examined ISMCs over-expressed PD-L1.

Conclusion/Implications All examined ISMCs over-expressed PD-L1. ISMC showed significantly higher PD-L1 expression than other EACs and worse survival than UEA. Our data suggest that PD-L1 over-expression is associated with poor prognosis of ISMC.

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