Comparison of the Prognostic Value of Ki-67 and Programmed Cell Death Ligand-1 in Patients with Upper Tract Urothelial Carcinoma

Abstract

We retrospectively enrolled 102 patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy to examine the prognostic value of Ki-67 and programmed cell death ligand-1 (PD-L1). Then, we performed PD-L1 and Ki-67 immunohistochemical staining on whole tissue sections. The cut-off value of PD-L1 positivity was a combined positive score (CPS) ≥10 and the Ki-67 overexpression was 20%. Among the 102 patients, 16.7% and 48.0% showed positive PD-L1 expression and Ki-67 overexpression, respectively. A CPS ≥10 was significantly associated with a higher pathological T stage (p = 0.049). In addition, Ki-67 overexpression was significantly associated with a pathological T stage ≥ 2 (p = 0.027) and tumour necrosis (p = 0.016). In the multivariable analysis, a positive PD-L1 expression was significantly correlated with worse cancer-specific survival (HR = 3.66, 95% CI =1.37−9.77, p = 0.01). However, there was no predictive value using a combination of PD-L1 expression and Ki-67 overexpression as a prognostic predictor. Compared with Ki-67 overexpression, a positive PD-L1 expression with CPS ≥ 10 was a stronger independent prognostic factor for CSS in patients with UTUC.

Prognostic value of programmed death ligand‐1 and programmed death‐1 expression in patients with upper tract urothelial carcinoma

“…This independent prognostic value of PD-L1 and PD-1 expression stand in multivariable analyses, even after adjusting for the alternative expression of PD-1 and PD-L1, respectively. Our findings are in line with those from previous reports also showing that PD-L1 [16,18,19,[25][26][27] or PD-1 [9,16,22] expression could be associated with decreased RFS, CSS and OS. Nonetheless, other reports did not find any prognostic value of PD-L1 or PD-1 expression [17,24,26,28], while the largest study to date suggested that PDL-1 expression was associated with prolonged RFS and OS but only in patients with organ-confined disease [9].…”

“…It is noteworthy that the rate of PD‐L1 expression on tumour cells of 22.3% observed in our study fell into the range reported in the literature varying from 16.7% to 29.7% [7–9,16–20], when excluding an outlier study suggesting PD‐L1 expression in up to 55% of patients with UTUC [21]. Although we found that only 32.2% of included patients expressed PD‐1 on TILs, this was close to the range reported in the literature varying from 37.2% to 57% [7,9,22].…”

“…It is noteworthy that the rate of PD-L1 expression on tumour cells of 22.3% observed in our study fell into the range reported in the literature varying from 16.7% to 29.7% [7][8][9][16][17][18][19][20], when excluding an outlier study suggesting PD-L1 expression in up to 55% of patients with UTUC [21].…”

ANXA10 Expression Is Inversely Associated with Tumor Stage, Grade, and TP53 Expression in Upper and Lower Urothelial Carcinoma

“…According to our previous studies and others, TP53 immunostaining was considered positive, when >10% of tumor cells were stained with a strong overexpression of TP53 [19][20][21][22]. The Ki-67 labeling index (Ki-67 LI) was scored as Ki-67 LI ≥20% or Ki-67 LI <20% [23,24]. The evaluation of HER2, EGFR, FGFR, and PD-L1 was described previously [22].…”

Risk factors for extraurothelial recurrence in upper tract urothelial carcinoma after radical nephroureterectomy: a retrospective study based on a Chinese population

“…Ki-67 is an immunostaining marker of nuclear cell proliferation, which is frequently expressed in several malignancies, such as breast, colon, and ovarian cancers ( 33 , 34 ). Referring to relevant literature, we defined that Ki-67 overexpression was 20% ( 33 – 35 ). In our study, 43.2% of the patients showed Ki-67 overexpression, which is consistent with the percentage of Ki-67 ≥20% in previous studies ( 36 , 37 ).…”