BMC Urology (Apr 2024)

PD-L1 expression in tumor and inflammatory cells is associated with favorable tumor features and favorable prognosis in muscle-invasive urothelial carcinoma of the bladder not treated by immune checkpoint inhibitors

  • Henning Plage,
  • Kira Furlano,
  • Sebastian Hofbauer,
  • Sarah Weinberger,
  • Bernhard Ralla,
  • Antonia Franz,
  • Annika Fendler,
  • Michela de Martino,
  • Florian Roßner,
  • Sefer Elezkurtaj,
  • Martina Kluth,
  • Maximilian Lennartz,
  • Niclas C. Blessin,
  • Andreas H. Marx,
  • Henrik Samtleben,
  • Margit Fisch,
  • Michael Rink,
  • Marcin Slojewski,
  • Krystian Kaczmarek,
  • Thorsten Ecke,
  • Steffen Hallmann,
  • Stefan Koch,
  • Nico Adamini,
  • Henrik Zecha,
  • Sarah Minner,
  • Ronald Simon,
  • Guido Sauter,
  • Joachim Weischenfeldt,
  • Tobias Klatte,
  • Thorsten Schlomm,
  • David Horst,
  • Simon Schallenberg

DOI
https://doi.org/10.1186/s12894-024-01482-z
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 9

Abstract

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Abstract Background A high level of PD-L1 expression is the most relevant predictive parameter for response to immune checkpoint inhibitor (CPI) therapy in urinary bladder cancer. Existing data on the relationship between PD-L1 expression and the natural course of disease are controversial and sparse. Methods To expand our understanding of the relationship between PD-L1 expression and parameters of cancer aggressiveness, PD-L1 was analyzed on tissue microarrays containing 2710 urothelial bladder carcinomas including 512 patients with follow-up data who underwent radical cystectomy and follow-up therapies in the pre-immune checkpoint inhibitor therapy era. Results Tumor cell positivity in ≥10% of cells were seen in 513 (20%) and an immune cell positivity occurred in 872 (34%) of 2566 interpretable cancers. PD-L1 positivity in tumor cells increased from pTaG2 low grade (0.9% positive) to pTaG3 high grade (4.1%; p = 0.0255) and was even higher in muscle-invasive (pT2–4) carcinomas (29.3%; p < 0.0001). However, within pT2–4 carcinomas, PD-L1 positivity was linked to low pT stage (p = 0.0028), pN0 (p < 0.0001), L0 status (p = 0.0005), and a better prognosis within 512 patients with cystectomy who never received CPIs (p = 0.0073 for tumor cells and p = 0.0086 for inflammatory cells). PD-L1 staining in inflammatory cells was significantly linked to PD-L1 staining in tumor cells (p < 0.0001) and both were linked to a positive p53 immunostaining (p < 0.0001). Conclusion It cannot be fully excluded that the strong statistical link between PD-L1 status and favorable histological tumor features as well as better prognosis could influence the outcome of studies evaluating CPIs in muscle-invasive urothelial carcinoma.

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