Prognostic and Therapeutic Implications of Immune Classification by CD8+ Tumor-Infiltrating Lymphocytes and PD-L1 Expression in Sinonasal Squamous Cell Carcinoma

Sinonasal squamous cell carcinoma (SNSCC) is an aggressive tumor predominantly arising in the maxillary sinus and nasal cavities. Advances in imaging, surgical and radiotherapeutic techniques have reduced complications and morbidity; however, the prognosis generally remains poor, with an overall 5-year survival rate of 30-50%. As immunotherapy may be a new therapeutic option, we analyzed CD8(+) tumor-infiltrating lymphocytes (TILs) and the tumor microenvironment immune type (TMIT, combining CD8(+) TILs and PD-L1) in a series of 57 SNSCCs. Using immunohistochemistry, tissue samples of 57 SNSCCs were analyzed for expression of CD8 on TILs and of PD-L1 on tumor cells. The results were correlated to the clinical and survival data. In total, 88% (50/57) of the tumors had intratumoral CD8(+) TILs; 19% (11/57)-CD8(high) (>10%); and 39/57 (68%)-CD8(low) (1-10%). PD-L1 positivity (>5%) was observed in 46% (26/57) of the SNSCCs and significantly co-occurred with CD8(+) TILs (p = 0.000). Using univariate analysis, high intratumoral CD8(+) TILs and TMIT I (CD8(high)/PD-L1(pos)) correlated with a worse survival rate. These results indicate that SNSCCs are immunogenic tumors, similar to head and neck squamous cell carcinomas. Nineteen percent of the cases were both CD8(high) and PD-L1(pos) and this subgroup may benefit from therapy with immune checkpoint inhibitors.

Automated summary

Sinonasal squamous cell carcinoma (SNSCC) is an aggressive tumor with a poor prognosis. Immunotherapy may be a new therapeutic option for SNSCC patients, especially for the subgroup with high CD8(+) TILs and PD-L1 positivity.