Hubungan ekspresi programmed death-ligand 1 (PD-L1) dengan profil klinikopatologi karsinoma nasofaring undifferentiated subtype di RSUP Prof. dr. I.G.N.G. Ngoerah Denpasar
Authors: Megadasari Anak Agung Prami , Sumadi I Wayan Juli , Dewi I Gusti Ayu Sri Mahendra 
Published: September 2024

Background: Nasopharyngeal Carcinoma (NPC) is a malignant neoplasm originating from the surface epithelium of the nasopharyngeal mucosa, which shows squamous differentiation. NPC is often associated with Epstein Barr Virus (EBV) infection, leading to increased PD-L1 expression. This study aims to determine the relationship between PD-L1 expression in tumor cells and immune cells and the clinicopathological profile of NPC.
Methods: This study used a cross-sectional analytical study design. Thirty-three samples were taken from paraffin blocks of patients who underwent initial biopsy at Prof. I.G.N.G Ngoerah Hospital between 2019 and 2022. Samples were collected using consecutive sampling techniques and subjected to immunohistochemistry (IHC) staining with PD-L1 antibody (clone 28-8, CellMerQ). HE slides were reviewed to assess histopathological types. The results of PD-L1 IHC staining, including tumor cells (TCS) and immunoreactive score (IRS), were correlated with NPC clinicopathological variables, including age, gender, histopathological type, and stage. Statistical analysis was performed using Chi-Square and Fisher Exact tests, with a significance level of p<0.05 and a 95% confidence interval.
Results: The mean age of subjects in this study was 53.58 years, with a median value of 55 years; 48.5% were aged <55 years, and 51.5% were aged ≥55 years. Twenty-three individuals (63.7%) were male, and 10 (27.3%) were female. There was a significant association between PD-L1 expression in tumor cells and patient age (p = 0.008). Significant associations were found between PD-L1 expression in tumors and immune cells with clinical stage (p = 0.024 and p = 0.024, respectively). There was a significant association between PD-L1 expression in tumor cells and PD-L1 expression in immune cells (p = <0.001). No significant associations were found between PD-L1 expression in immune cells and age (p = 0.055) and between PD-L1 expression in tumor cells and immune cells with gender (p = 0.105 and p = 0.105, respectively).
Conclusion: There is a significant association between PD-L1 expression in tumor cells and patient age and clinical stage. There is also a significant association between PD-L1 expression in immune cells and the clinical stage. Additionally, there is a significant association between PD-L1 expression in tumor cells (TCS) and PD-L1 expression in immune cells (IRS).
 
Latar Belakang: Karsinoma nasofaring (KNF) adalah neoplasma ganas yang berasal dari epitel permukaan mukosa nasofaring yang menunjukkan diferensiasi skuamosa. KNF sering dikaitkan dengan infeksi Epistein Barr Virus (EBV) yang menyebabkan meningkatnya ekspresi PD-L1. Penelitian ini bertujuan untuk membuktikan adanya hubungan antara ekspresi PD-L1 sel tumor dan sel imun dengan profil klinikopatologi pasien KNF.
Metode: Penelitian ini menggunakan rancangan penelitian analitik potong lintang. Tiga puluh tiga sampel diambil dari blok parafin pasien yang dilakukan biopsi pertama di RSUP Prof I.G.N.G Ngoerah antara tahun 2019 sampai dengan tahun 2022. Sampel dikumpulkan dengan teknik consecutive sampling kemudian dilakukan pulasan imunohistokimia (IHK) dengan antibodi PD-L1 (clone 28-8, CellMerQ). Evaluasi ulang sediaan HE dilakukan untuk menilai tipe histopatologi. Hasil pulasan IHK PD-L1 berupa tumor cells (TCS)  dan immune reactive score (IRS) dihubungkan dengan variabel klinikopatologi KNF, meliputi umur, jenis kelamin, tipe histopatologi dan stadium. Uji statistik menggunakan uji Chi-Squre dan Fisher Exact, dengan tingkat kemaknaan p<0,05 dan interval kepercayaan 95%.
Hasil: Rerata usia subyek pada penelitian ini adalah 53,58 tahun dengan nilai median 55 tahun, 48,5% berusia <55 tahun dan 51,5 % berusia ≥55 tahun. Dua puluh tiga orang (63,7%) berjenis kelamin laki-laki dan 10 orang (27,3%) berjenis kelamin perempuan. Terdapat hubungan yang bermakna antara ekspresi PD-L1 sel tumor dengan usia pasien (p=0,008). Terdapat hubungan yang bermakna antara ekspresi PD-L1 sel tumor dan sel imun dengan stadium klinis (p=0,024 dan p=0,024). Terdapat hubungan yang bermakna antara ekspresi PD-L1 sel tumor dengan ekspresi PD-L1 sel imun (p=<0,001). Tidak terdapat hubungan bermakna antara ekspresi PD-L1 sel imun dengan usia (p=0,055), Tidak terdapat hubungan bermakna antara ekspresi PD-L1 sel tumor dan sel imun dengan jenis kelamin (p=0,105 dan p=0,105).
Kesimpulan: Terdapat hubungan yang bermakna antara ekspresi PD-L1 sel tumor dengan umur pasien dan stadium klinis. Terdapat hubungan yang bermakna antara ekspresi PD-L1 sel imun dengan stadium klinis. Terdapat hubungan yang bermakna antara ekspresi PD-L1 sel tumor (TCS) dengan ekspresi PD-L1 sel imun (IRS).