Theranostics 2019; 9(16):4678-4687. doi:10.7150/thno.36276 This issue

Research Paper

Distinct PD-L1/PD1 Profiles and Clinical Implications in Intrahepatic Cholangiocarcinoma Patients with Different Risk Factors

Jia-Cheng Lu1,2*, Hai-Ying Zeng3*, Qi-Man Sun1*, Qing-Nan Meng1*, Xiao-Yong Huang1*, Peng-Fei Zhang1, Xuan Yang1, Rui Peng1, Chao Gao1, Chuan-Yuan Wei1, Ying-Hao Shen1, Jia-Bing Cai1, Rui-Zhao Dong1, Ying-Hong Shi1, Hui-Chuan Sun1, Yujiang G. Shi4, Jian Zhou1,2, Jia Fan1,2, Ai-Wu Ke1,2✉, Liu-Xiao Yang5✉, Guo-Ming Shi1,2✉

1. Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai 200032, P.R. China
2. Cancer Center, Institutes of Biomedical Sciences, Fudan University, Shanghai 200031, P.R. China
3. Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
4. Division of Endocrinology, Diabetes and Hypertension, Departments of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
5. Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
*Authors contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution License ( See for full terms and conditions.
Lu JC, Zeng HY, Sun QM, Meng QN, Huang XY, Zhang PF, Yang X, Peng R, Gao C, Wei CY, Shen YH, Cai JB, Dong RZ, Shi YH, Sun HC, Shi YG, Zhou J, Fan J, Ke AW, Yang LX, Shi GM. Distinct PD-L1/PD1 Profiles and Clinical Implications in Intrahepatic Cholangiocarcinoma Patients with Different Risk Factors. Theranostics 2019; 9(16):4678-4687. doi:10.7150/thno.36276. Available from

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Graphic abstract

Rationale: PD1/PD-L1 immune checkpoint inhibitors have shown promising results for several malignancies. However, PD1/PD-L1 signaling and its therapeutic significance remains largely unknown in intrahepatic cholangiocarcinoma (ICC) cases with complex etiology.

Methods: We investigated the expression and clinical significance of CD3 and PD1/PD-L1 in 320 ICC patients with different risk factors. In addition, we retrospectively analyzed 7 advanced ICC patients who were treated with PD1 inhibitor.

Results: The cohort comprised 233 patients with HBV infection, 18 patients with hepatolithiasis, and 76 patients with undetermined risk factors. PD-L1 was mainly expressed in tumor cells, while CD3 and PD1 were expressed in infiltrating lymphocytes of tumor tissues. PD1/PD-L1 signals were activated in tumor tissues, and expression was positively correlated with HBV infection and lymph node invasion. More PD1+ T cells and higher PD-L1 expression were observed in tumor tissues of ICC patients with HBV infection compared to patients with hepatolithiasis or undetermined risk factors. More PD1+ T cells and/or high PD-L1 expression negatively impacted the prognosis of patients with HBV infection but not those with hepatolithiasis. Multivariate analysis showed PD1/PD-L1 expression was an independent indicator of ICC patient prognosis. Advanced ICC patients with HBV infection and less PD1+ T cells tended to have good response to anti-PD1 therapy.

Conclusion: Hyperactivated PD1/PD-L1 signals in tumor tissues are a negative prognostic marker for ICCs after resection. HBV infection- and hepatolithiasis-related ICCs have distinct PD1/PD-L1 profiles. Further, PD1+ T cells could be used as a biomarker to predict prognosis and assay the efficiency of anti-PD1 immunotherapy in ICC patients with HBV infection.

Keywords: intrahepatic cholangiocarcinoma, hepatitis B virus, hepatolithiasis, programmed cell death protein 1, programmed cell death protein ligand 1, immune checkpoint blockage