Lu Yi, Kang Jiaqi, Luo Zhiwen, Song Yuxuan, Tian Jia, Li Zhongjia, Wang Xiao, Liu Li, Yang Yongjiao, Liu Xiaoqiang
Department of Urology, Tianjin Medical University General Hospital, Tianjin, China.
Department of Hepatology, National Clinical Research Center for Cancer and Cancer Hospital, Beijing, China.
Front Oncol. 2020 Aug 21;10:1400. doi: 10.3389/fonc.2020.01400. eCollection 2020.
Several studies investigating the role of PD-L1 in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) to predict prognosis had been published and great controversy existed among them. We, therefore, in the meta-analysis, reported the association between PD-L1 and survival in UTUC patients who underwent RNU. We searched the PubMed, Cochrane Library, EMBASE, and Web of Science by April 1, 2020. Hazard ratio (HR) and odds ratio (OR) were adopted to evaluate relationships between PD-L1 and survival outcomes, and tumor features, respectively. We formulated clinical questions and organized following the PICOS strategy. Eight retrospective studies incorporating 1406 patients were included. The pooled positive rate of PD-L1 in UTUC patients was 21.0% (95% CI = 13.0-30.0%, = 95.3%). Furthermore, higher PD-L1 in tumor tissues was related to shorter cancer-specific survival (CSS) in radically resected UTUC patients (HR = 1.63, 95% CI = 1.17-2.26, = 0.0%), but was not associated with overall survival (OS) (HR = 1.49, 95% CI = 0.76-2.91, = 74.9%). Subgroup analyses indicated associations between higher PD-L1 and shorter CSS in both Caucasus (HR = 1.72, 95% CI = 1.02-2.92, = 0.0%) and Asian (HR = 1.57, 95% CI = 1.03-2.39, = 23.1%) UTUC patients. Furthermore, PD-L1 was related to tumor grade of UTUC (High vs. Low, OR = 3.56, 95% CI = 1.82-6.97, = 0.000) and invasive depth (pT3+pT4+pT2 vs. pT1+pTa/pTis, OR = 2.53, 95% CI = 1.07-5.96, = 0.001). In the cumulative meta-analysis, results indicated that the 95% CIs narrowed as the pooled results gradually moved near the null. PD-L1 overexpression was related to worse survival outcomes in UTUC patients after RNU. It may be useful to incorporate PD-L1 into prognostic tools to select appropriate treatment strategies for UTUC. PD-L1 can also be clinically used for survival anticipation, risk stratification, and patient counseling. However, the pooled findings should be considered tentative until ascertained by more researches.
多项研究探讨了程序性死亡配体1（PD-L1）在根治性肾输尿管切除术（RNU）后上尿路尿路上皮癌（UTUC）患者中预测预后的作用，这些研究已发表，但彼此之间存在很大争议。因此，在这项荟萃分析中，我们报告了接受RNU的UTUC患者中PD-L1与生存之间的关联。我们在2020年4月1日前检索了PubMed、Cochrane图书馆、EMBASE和科学网。采用风险比（HR）和优势比（OR）分别评估PD-L1与生存结局以及肿瘤特征之间的关系。我们制定了临床问题并按照PICOS策略进行组织。纳入了8项纳入1406例患者的回顾性研究。UTUC患者中PD-L1的合并阳性率为21.0%（95%置信区间=13.0-30.0%，I²=95.3%）。此外，肿瘤组织中较高的PD-L1与根治性切除的UTUC患者较短的癌症特异性生存（CSS）相关（HR=1.63，95%置信区间=1.17-2.26，P=0.0%），但与总生存（OS）无关（HR=1.49，95%置信区间=0.76-2.91，P=74.9%）。亚组分析表明，在高加索（HR=1.72，95%置信区间=1.02-2.92，P=0.0%）和亚洲（HR=1.57，95%置信区间=1.03-2.39，P=23.1%）UTUC患者中，较高的PD-L1与较短的CSS均相关。此外，PD-L1与UTUC的肿瘤分级相关（高分级与低分级，OR=3.56，95%置信区间=1.82-6.97，P=0.000）以及浸润深度相关（pT3+pT4+pT2与pT1+pTa/pTis，OR=2.53，95%置信区间=1.07-5.96，P=0.001）。在累积荟萃分析中，结果表明随着合并结果逐渐接近无效值，95%置信区间变窄。RNU后UTUC患者中PD-L1过表达与较差的生存结局相关。将PD-L1纳入预后工具以选择适合UTUC的治疗策略可能是有用的。PD-L1在临床上也可用于生存预期、风险分层和患者咨询。然而，在更多研究确定之前，合并的研究结果应被视为初步的。
