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Original Article | Open Access

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

Li Liu1, Chenya Zhuo1,2 ( ), Tingting Zhao1, Qiongshan Liu3, Yun Liu1, Jingran Du1, Dandan Yan1, Qiuxiao Tan1, Hui Fei1( ), Xiaohui Tian1( ), Mengxiong Li1( )
Department of Gynecology and Obstetrics, The Seventh Affiliated Hospital, Sun Yat‐sen University, Shenzhen, China
The Biobank, Institute of Translational Medicine, The Seventh Affiliated Hospital, Sun Yat‐sen University, Shenzhen, China
International Medical Center, The Seventh Affiliated Hospital, Sun Yat‐sen University, Shenzhen, China

Li Liu, Chenya Zhuo, and Tingting Zhao contributed equally to this work.

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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 (rs = 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 overall survival (OS) (p = 0.01); the TAMhigh/PD-L1+ group exhibited the shortest OS, while the TAMlow/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.

Graphical Abstract

Tumor‐associated macrophages (TAMs) drive ovarian cancer (OC) progression and immune escape mainly via programmed death‐ligand 1 (PD‐L1) upregulation. This study aimed to construct a risk stratification model integrating these two immune biomarkers for OC precision prognosis. A tissue microarray cohort containing 124 OC specimens with complete clinicopathological and follow‐up data was enrolled. CD204 H‐score quantified TAM infiltration, and combined positive score (CPS) assessed PD‐L1 expression. CD204 H‐score showed a moderate positive correlation with PD‐L1 CPS (rs = 0.42, p < 0.001). TAM infiltration independently predicted advanced pathological grade (p = 0.03); PD‐L1 negative and positive group had significantly different OS (p = 0.01); the TAMhigh/PD‐L1+ group exhibited the shortest OS, while the TAMlow/PD‐L1− group had the most favorable outcomes (p = 0.03). The TAMs/PD‐L1 immune axis is associated with adverse prognosis in OC. Our dual‐biomarker stratification model may provide a framework for risk stratification of long‐term OS, highlighting translational value requiring prospective validation.

Keywords

ovarian cancerPD‐L1prognostic stratificationtumor‐associated macrophage

References

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Organ Medicine
Volume 3 Issue 3,
September 2026
Pages 148-156
DOI: 10.1002/orm2.70050

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Cite this article:
Liu L, Zhuo C, Zhao T, et al. A Prognostic Stratification Model for Ovarian Cancer Integrating the Tumor‐Associated Macrophages/Programmed Death‐Ligand 1 Axis. Organ Medicine, 2026, 3(3): 148-156. https://doi.org/10.1002/orm2.70050

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Received: 04 August 2026
Revised: 12 August 2026
Accepted: 17 August 2026
Published: 31 August 2026
© 2026 The Author(s).

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.