Prognostic significance of T-cell-inflamed gene expression profile and PD-L1 expression in patients with esophageal cancer

Purpose: The ability of the T-cell-inflamed gene expression profile (GEP) to predict clinical outcome in esophageal cancer (EC) is unknown. This retrospective observational study assessed the prognostic value of GEP and programmed death ligand 1 (PD-L1) expression in patients with EC treated in routine clinical practice.

Methods: Tumor samples of 294 patients from three centers in Denmark, South Korea, and the United States, collected between 2005 and 2017, were included. T-cell-inflamed GEP score was defined as non-low or low using a cutoff of -1.54. A combined positive score (CPS) ≥10 was defined as PD-L1 expression positivity. Associations between overall survival (OS) and GEP status and PD-L1 expression were explored by Cox proportional hazards models adjusting for age, sex, histology, stage, and performance status.

Results: Median age was 65 years; 63% of patients had adenocarcinoma (AC) and 37% had squamous cell carcinoma (SCC). Thirty-six percent of tumors were GEP non-low, with higher prevalence in AC (46%) than SCC (18%). Twenty-one percent were PD-L1-positive: 32% in South Korean samples versus 16% in non-Asian samples and 26% in SCC versus 18% in AC. GEP scores and PD-L1 CPS were weakly correlated (Spearman's R = 0.363). OS was not significantly associated with GEP status (non-low vs low; adjusted hazard ratio, 0.91 [95% CI, 0.69-1.19]) or PD-L1 expression status.

Conclusion: Neither GEP nor PD-L1 expression was a prognostic marker in Asian and non-Asian patients with EC.