PD-L1 Protein Expression Is Associated With Good Clinical Outcomes and Nomogram for Prediction of Disease Free Survival and Overall Survival in Breast Cancer Patients Received Neoadjuvant Chemotherapy

Abstract

ObjectiveThis study aims to investigate the potential prognostic significance of programmed death ligand-1 (PD-L1) protein expression in tumor cells of breast cancer patients received neoadjuvant chemotherapy (NACT).MethodsUsing semiquantitative immunohistochemistry, the PD-L1 protein expression in breast cancer tissues was analyzed. The correlations between PD-L1 protein expression and clinicopathologic characteristics were analyzed using Chi-square test or Fisher’s exact test. The survival curve was stemmed from Kaplan-Meier assay, and the log-rank test was used to compare survival distributions against individual index levels. Univariate and multivariate Cox proportional hazards regression models were accessed to analyze the associations between PD-L1 protein expression and survival outcomes. A predictive nomogram model was constructed in accordance with the results of multivariate Cox model. Calibration analyses and decision curve analyses (DCA) were performed for the calibration of the nomogram model, and subsequently adopted to assess the accuracy and benefits of the nomogram model.ResultsA total of 104 breast cancer patients received NACT were enrolled into this study. According to semiquantitative scoring for IHC, patients were divided into: low PD-L1 group (61 cases) and high PD-L1 group (43 cases). Patients with high PD-L1 protein expression were associated with longer disease free survival (DFS) (mean: 48.21 months vs. 31.16 months; P=0.011) and overall survival (OS) (mean: 83.18 months vs. 63.31 months; P=0.019) than those with low PD-L1 protein expression. Univariate and multivariate analyses indicated that PD-L1, duration of neoadjuvant therapy, E-Cadherin, targeted therapy were the independent prognostic factors for patients’ DFS and OS. Nomogram based on these independent prognostic factors was used to evaluate the DFS and OS time. The calibration plots shown PD-L1 based nomogram predictions were basically consistent with actual observations for assessments of 1-, 3-, and 5-year DFS and OS time. The DCA curves indicated the PD-L1 based nomogram had better predictive clinical applications regarding prognostic assessments of 3- and 5-year DFS and OS, respectively.ConclusionHigh PD-L1 protein expression was associated with significantly better prognoses and longer DFS and OS in breast cancer patients. Furthermore, PD-L1 protein expression was found to be a significant prognostic factor for patients who received NACT.

PDL1-Based Nomogram May Be of Potential Clinical Utility for Predicting Survival Outcome in Stage III Breast Cancer

“…In Chen’s study, they performed that low PD-L1 protein expression was associated with significantly worse prognoses and shorter DFS and OS in breast cancer patients, and the protein expression of PDL1 was found to be a significant prognostic factor for patients who received neoadjuvant chemotherapy. 42 The results of this study were basically consistent with ours. Their enrolled patients were received neoadjuvant chemotherapy; however, our enrolled patients were stage III breast cancer without undergoing adjuvant therapy.…”

Critical role of VHL/BICD2/STAT1 axis in crystal-associated kidney disease

“…S2A–C ). Through immunohistochemical analysis and semiquantitative evaluation of VHL immunopositivity according to previous studies [ 25 , 26 ], we found that the expression of VHL was predominantly upregulated in renal epithelial cells (RECs) during CaOx nephrocalcinosis (Fig. S2D, E ).…”

“…The immunohistochemical score of VHL was performed using a semiquantitative system as demonstrated previously [ 25 , 26 ]. Briefly, histological analyses were performed by combining the density and intensity of positive staining cells.…”

A real‐world study of immune checkpoint inhibitors in advanced triple‐negative breast cancer

“…Previous studies have shown that PD1, PD‐L1, TILs, and TMB may be potential biomarkers related to the efficacy of immunotherapy [ 19 , 20 , 21 , 22 ]. A French study retrospectively analyzed the correlation between TILs and clinical outcomes after immunotherapy and chemotherapy in patients with advanced nonsmall cell lung cancer (NSCLC), and the results showed that patients with high density of TILs had a lower risk of death and disease recurrence, and a higher ORR when treated with Nivolumab, while no similar phenomenon was observed in the chemotherapy group [ 23 ].…”