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Background <p>Pancreatic ductal adenocarcinoma (PDAC) frequently exhibits an immunosuppressive microenvironment coupled with malnutrition status. These features are instrumental in clinical management strategies for PDAC.</p> Methods <p>Immune-nutrition status of patients was evaluated by integrating systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI). Individuals were divided into SII-PNI Status positive (SPS<sup>+</sup>) group and SPS negative (SPS<sup>−</sup>) group. Morphology of tissues was evaluated by hematoxylin-eosin (H&amp;E) staining. Expression of PD-L1 and p53 was detected using immunohistochemistry (IHC).</p> Results <p>In this study, 530 eligible patients (mean ± SD age, 60.5 ± 9.17 years, 296 males [55.8%], 74 SPS<sup>+</sup> [14.0%]) were included. These patients exhibited a median survival of 24 months (1-, 3- and 5-year survival rate; 72.9%, 34.7% and 25.1%, respectively). In the multivariate analysis, independent indicators for outcomes were identified as tumor size, lymph node metastasis and SPS (all <i>p</i> &lt;.01). After matching and adjusting, patients with SPS<sup>+</sup> exhibited a notably reduced overall survival compared to those with SPS<sup>−</sup> (14 vs. 25 months, <i>p</i> &lt;.001), with hazard ratio (95% CI) of 1.79 (1.25–2.56). IHC revealed markedly elevated positive cell proportion of PD-L1 in SPS<sup>+</sup> group (<i>p</i> &lt;.01) and distinct p53 mutation patterns between SPS<sup>+</sup> and SPS<sup>−</sup> groups (<i>p</i> =.03). Morphology demonstrated a dissimilar trend of differentiation levels between the two groups (<i>p</i> =.08).</p> Conclusion <p>The findings suggest poorer outcome, higher PD-L1 expression and distinct p53 mutation status of patients with SPS<sup>+</sup>. These patterns may contribute to PDAC management and strategic deployment of immunotherapy and targeted therapy.</p>

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PD-L1 levels, TP53 mutation profiles, and survival outcomes in pancreatic cancer differ by immune-nutritional status

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月29日

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  • Zheng Li,
  • Hu Ren,
  • Shihui Zhang,
  • Chongyuan Sun,
  • Zefeng Li,
  • Penghui Niu,
  • He Fei,
  • Cheng Xing,
  • Susheng Shi,
  • Dongbing Zhao

摘要

Background

Pancreatic ductal adenocarcinoma (PDAC) frequently exhibits an immunosuppressive microenvironment coupled with malnutrition status. These features are instrumental in clinical management strategies for PDAC.

Methods

Immune-nutrition status of patients was evaluated by integrating systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI). Individuals were divided into SII-PNI Status positive (SPS+) group and SPS negative (SPS−) group. Morphology of tissues was evaluated by hematoxylin-eosin (H&E) staining. Expression of PD-L1 and p53 was detected using immunohistochemistry (IHC).

Results

In this study, 530 eligible patients (mean ± SD age, 60.5 ± 9.17 years, 296 males [55.8%], 74 SPS+ [14.0%]) were included. These patients exhibited a median survival of 24 months (1-, 3- and 5-year survival rate; 72.9%, 34.7% and 25.1%, respectively). In the multivariate analysis, independent indicators for outcomes were identified as tumor size, lymph node metastasis and SPS (all p <.01). After matching and adjusting, patients with SPS+ exhibited a notably reduced overall survival compared to those with SPS− (14 vs. 25 months, p <.001), with hazard ratio (95% CI) of 1.79 (1.25–2.56). IHC revealed markedly elevated positive cell proportion of PD-L1 in SPS+ group (p <.01) and distinct p53 mutation patterns between SPS+ and SPS− groups (p =.03). Morphology demonstrated a dissimilar trend of differentiation levels between the two groups (p =.08).

Conclusion

The findings suggest poorer outcome, higher PD-L1 expression and distinct p53 mutation status of patients with SPS+. These patterns may contribute to PDAC management and strategic deployment of immunotherapy and targeted therapy.