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β-catenin and PD-L1 expression in mismatch repair deficient endometrial carcinomas
  1. Margaret Rowe1,
  2. Rahul Krishnan2,
  3. Anne Mills3 and
  4. Kari Ring2
  1. 1University of Virginia School of Medicine, Charlottesville, Virginia, USA
  2. 2Obstetrics & Gynecology, University of Virginia Health System, Charlottesville, Virginia, USA
  3. 3Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
  1. Correspondence to Dr Kari Ring, Division of Gynecologic Oncology, Obstetrics & Gynecology Dept., University of Virginia, Charlottesville, Virginia, United States; kel7j{at}


Introduction Predictors of non-response in mismatch repair deficiency cancers are poorly understood. Upregulation of the canonical Wnt pathway has been associated with decreased immune cell infiltration in many cancer types. The relationship between Wnt/β-catenin pathway activation and the programmed death-ligand 1 axis in endometrial cancer remains poorly characterized. This study evaluates β-catenin expression in a well characterized cohort of endometrial cancers by mismatch repair status and programmed death-ligand 1 expression.

Methods Whole sections of formalin-fixed, paraffin embedded tissue from 23 Lynch syndrome-associated carcinomas, 20 mutL homolog-1 (MLH1) promoter hypermethylated carcinomas, and 19 mismatch repair intact carcinomas were evaluated. Immunohistochemistry staining for β-catenin and programmed death-ligand 1 was performed on all cases. Programmed death-ligand 1 expression was scored in both the tumor and the peri-tumoral immune compartment. Tumor staining was classified as positive when membranous (programmed death-ligand 1) staining was present in ≥1% of tumor cells. Immune stromal staining was scored as positive when ≥5% of peritumoral and intratumoral immune cells (including lymphocytes and macrophages) showed reactivity.

Results Six tumors (6/62, 9.7%) demonstrated nuclear expression of β-catenin (4 were Lynch syndrome-associated, 1 was MLH1 methylated, 1 was mismatch repair intact). The majority of tumors with nuclear β-catenin expression demonstrated concomitant tumoral programmed death-ligand 1 expression (5/6, 83.3%) and were more likely to demonstrate tumoral programmed death-ligand 1 expression compared to tumors without nuclear β-catenin expression (83.3% vs 39.3%, p=0.04). Both tumoral and immune cell expression of programmed death-ligand 1 was statistically significantly associated with mismatch repair deficient tumors.

Discussion Tumors demonstrating nuclear β-catenin expression were more likely to express tumoral programmed death-ligand 1 staining than tumors without nuclear β-catenin expression. Nuclear β-catenin expression could be a potential predictive biomarker for non-response to immune checkpoint inhibition in mismatch repair deficient tumors. Nuclear β-catenin expression status should be considered as a translational endpoint in future clinical trials of immune checkpoint inhibition in endometrial cancer.

  • endometrial neoplasms
  • lynch syndrome II
  • uterine neoplasms
  • pathology

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  • Correction notice Since the online publication of this article, the title was updated to include the abbreviation 'PD-L1'

  • Contributors All authors (MR, RK, AM and KR) substantially contributed to study design, acquisition, and analysis of data collected. All authors (MR, RK, AM and KR) drafted and/or provided critical revisions to the manuscript. All authors (MR, RK, AM and KR) have approved the final manuscript and are accountable for all aspects of the work submitted.

  • 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.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. De-identified research data available upon request. Requests can be sent to Anne Mills, MD (