Clinical relevance and prognostic role of PDL-1 expression in cervical cancer patients

Background: PD-L1 has emerged as an important prognostic and predictive biomarker in cervical cancer. Its expression may be associated with tumor histotype, grade, tumor-infiltrating lymphocytes (TILs), and clinical outcomes, including response to neoadjuvant chemotherapy (NACT). Methods: We retrospectively analyzed 59 patients with locally advanced cervical cancer. Pre-treatment biopsies were assessed for histotype, grade, TILs, eosinophils, and PD-L1 expression using the combined positive score (CPS). Clinical and pathological features were correlated with PD-L1 expression and with pathological response after NACT and surgery. Results: PD-L1 positivity was detected in 76% of patients, with higher prevalence in squamous cell carcinoma and in tumors with TILs. Elevated CPS values were significantly associated with high-grade tumors, advanced age, multiple pregnancies, and eosinophil-rich stroma. PD-L1 expression in immune cells correlated with lack of response to NACT, whereas PD-L1 expression in tumor cells correlated with necrosis and higher response rates. Conclusion: PD-L1 expression is frequent in cervical cancer and correlates with adverse pathological features. The distribution of PD-L1 between tumor and immune cells appears to influence response to NACT, suggesting that localization should be considered alongside CPS in stratifying patients for immunotherapy.