Cancer Immunol Res. 2021 Sep 15. pii: canimm.0144.2021. [Epub ahead of print]
Immunotherapy, including PD-1/PD-L1 agonists, has shown limited efficacy in pancreatic ductal adenocarcinoma (PDAC). We examined the PD-1/PD-L1 expression and immunoarchitectural features by automated morphometric analysis using multiplex immunofluorescence and 118 microsatellite-stable, treatment-naïve, surgically resected PDACs (study cohort). Five microsatellite-instable cases were stained in parallel (MSI cohort). Molecular analysis was additionally performed. An independent PDAC-cohort (n=226) was immunostained for PD-L1and used as a validation cohort. PD-L1 expression on tumor cells (TCs) and/or immune cells (ICs) was present in 32% and 30% of the study and validation cohorts, respectively, and assigned into one of four patterns: "adaptive-1" (TC:0, IC>1%), "adaptive-2" (TC>1%-<25%, IC>1%), "constitutive" (TC{greater than or equal to}25%, IC:0), and "combined" (TC{greater than or equal to}25%, IC>1%). "Constitutive" tumors were characterized by reduced numbers of all immune cells and poor outcome. In contrast, "adaptive-1" tumors exhibited abundant T cells, including high counts of cytotoxic CD3+CD8+ and PD-1+CD3+CD8+ cells, but low counts of PD-L1+CD3+CD8+ cells and associated with the best outcome. "Adaptive-2" tumors (median OS:13 months) displayed higher proportions of PD-L1+CD3+CD8+ T cells and tumor-associated macrophages (CD68+, CD68+CD206+) compared to "adaptive-1" tumors. In the "combined" pattern, extensive PD-L1 expression on TCs was accompanied by increased numbers of T cells and improved OS. ICs were closer to PD-L1- than to PD-L1+ PDAC cells. TP53 and PIK3CA alterations tended to be more frequent in PD-L1+ tumors. The 5 MSI cases were PD-L1-. The distinct PD-1/PD-L1-associated immunoarchitectural patterns underpin the heterogeneity of the immunological responses and might be used to inform patient outcomes and therapeutic decisions in pancreatic cancer.