Prognostic value of programmed cell death ligand-1 expression in patients with bladder urothelial carcinoma undergoing radical cystectomy: A meta-analysis

Abstract

BackgroundRadical cystectomy and removal of pelvic lymph nodes (RC-PLND) is a recommended treatment for high-risk non-muscle-invasive and muscle-invasive non-metastatic bladder cancer (BC). However, 50% of patients relapse after RC-PLND. This study aimed to evaluate the effect of programmed cell death ligand-1 (PD-L1) on the prognosis of bladder urothelial carcinoma (BUC) after RC-PLND.MethodsWe present this meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Guidelines. The main outcomes were overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) of 3 and 5 years after RC-PLND.ResultsOverall, 11 studies and 1393 BUC cases were included in our meta-analysis. In tumor cells (TCs), the PD-L1 negative group had statistically significant advantage in 5-year OS (risk ratio [RR]: 0.85, 95% confidence interval [CI]: 0.74–0.97, P = 0.02), RFS (RR: 0.76, 95% CI: 0.58–0.99, P = 0.04), and CSS (RR: 0.73, 95% CI: 0.58–0.92, P = 0.009) compared with the PD-L1 positive group. But, no statistically significant difference in 5-year OS and RFS was observed between the PD-L1 negative and positive groups in tumor-infiltrating immune cells.ConclusionsOur study found that patients with BUC who tested positive for PD-L1 in TCs had a poor prognosis after RC-PLND. PD-1 or PD-L1 inhibitors could be used as a adjuvant medication for patients with BUC after RC-PLND who exhibit PD-L1 overexpression in TCs.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022301424.

A novel grading approach predicts worse outcomes in stage pT1 non‐muscle‐invasive bladder cancer

“…Similarly, greater lymphocyte infiltration and high programmed death-ligand 1 (PD-L1) mRNA expression were linked to improved survival in stage pT1 NMIBC in prior research [20,21]. It is important to distinguish PD-L1 expression on tumour cells from PD-L1 expression on infiltrating lymphocytes since several studies associated a high PD-L1 expression on tumour cells with poor prognosis including worse OS and CSS, while PD-L1 expression on infiltrating lymphocytes had no negative impact on oncological outcomes [22]. One hypothesis for this is described in the literature as the ability of PD-L1 to promote immune escape.…”

Tumor immune microenvironment and the current immunotherapy of cholangiocarcinoma (Review)

“…An elevated expression of PD-L1 has been linked to tumor progression and a poorer prognosis. CCA tumors with a high PD-L1 expression tend to display more aggressive features and shorter survival times (124,125). CTLA-4 has also been observed to be upregulated in CCA, and of note, a significant positive correlation exists between the expression levels of PD-1 and CTLA-4 (126).…”

Integrating the PD-L1 Prognostic Biomarker in Non-Muscle Invasive Bladder Cancer in Clinical Practice—A Comprehensive Review on State-of-the-Art Advances and Critical Issues

“…While some authors have revealed worse survival rates in BC patients with elevated PD-L1 expression [34][35][36][37][38], others have failed to find such a correlation [39,40]. The prognostic role of PD-L1 has recently been the subject of five meta-analyses over a few recent years (2019-2022), with a variable number of studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and cases (1393-4032) assessed in each analysis due to different eligibility criteria and search strategy variables (including databases, interval time, and MeSH terms) [41][42][43][44][45] (Supplementary Table S1). The authors found a statistically significant association overall between the expression of TC PD-L1 and poorer outcome parameters.…”