A Prognostic Stratification Model for Ovarian Cancer Integrating the Tumor‐Associated Macrophages/Programmed Death‐Ligand 1 Axis

Vollständiger Abstract

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ABSTRACT Background Tumor‐associated macrophages (TAMs) drive ovarian cancer (OC) progression and immune escape mainly via programmed death‐ligand 1 (PD‐L1) upregulation. Elevated TAM infiltration correlates with poor OC prognosis, yet the combined prognostic stratification value of TAMs and PD‐L1 for ovarian malignancy remains poorly characterized. This study aimed to profile TAM infiltration and PD‐L1 expression, and construct a risk stratification model integrating these two immune biomarkers for OC precision prognosis. Methods A tissue microarray cohort containing 124 OC ovarian tissue specimens with complete clinicopathological and long‐term follow‐up data was enrolled. CD204 histochemical score (H‐score) quantified TAM infiltration, and combined positive score (CPS) assessed PD‐L1 expression. We analyzed their inter‐correlation, links with clinical parameters, then stratified patients into four subgroups according to median cut‐offs of CD204 H‐score and PD‐L1 negative or positive. Results CD204 H‐score showed a moderate positive correlation with PD‐L1 CPS ( r s = 0.42, p < 0.001). TAM infiltration independently predicted advanced pathological grade ( p = 0.03); CD204 H‑score and PD‑L1 CPS both varied significantly across pathological subtypes ( p < 0.001 vs. p = 0.04); PD‐L1 negative and positive group had significantly different OS ( p = 0.01); the TAM high /PD‑L1 + group exhibited the shortest OS, while the TAM low /PD‑L1 − group had the most favorable outcomes ( p = 0.03). Conclusions The TAMs/PD‐L1 immune axis is associated with immune suppression and adverse prognosis in OC. Our dual‐biomarker stratification model may provide a framework for risk stratification of long‐term OS and supports personalized immunotherapy risk stratification. Though it failed to stratify progression‐free survival (PFS) within this cohort, its robust OS predictive performance highlights translational value requiring prospective validation in larger tumor cohorts.