Lee Chung Un, Lee Dong Hyeon, Song Wan
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Urology, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, South Korea.
Front Oncol. 2021 Aug 20;11:706503. doi: 10.3389/fonc.2021.706503. eCollection 2021.
The aim of this study is to investigate the prognostic role of programmed death ligand-1 (PD-L1) on tumor-infiltrating immune cells (TIICs) in patients after radical cystectomy (RC) for bladder cancer (BCa).
We retrospectively reviewed 92 "high-risk" (≥pT3a and/or pN+) patients who underwent RC for BCa, without adjuvant chemotherapy (AC), between April 2014 and December 2019. PD-L1 on TIICs was measured only using the VENTANA (SP-142) immunohistochemistry assay. Patients were categorized into three groups based to the percentage of the tumor area covered by PD-L1 on TIICs: IC0 (<1%), IC1 (≥1% and <5%), and IC2/3 (≥5%). Positive PD-L1 was defined as IC2/3 (≥5%). Kaplan-Meier survival analysis was used to illustrate recurrence-free survival (RFS), and Cox proportional hazard models were used to identify predictive factors of tumor recurrence.
Within the cohort, the proportions of PD-L1 IC0, IC1, and IC2/3 were 21.7%, 23.9%, and 54.4%, respectively. At follow-up (mean 31.3 months), tumor recurrence was identified in 49 patients (53.3%). Using multivariable analysis, tumor stage (pT4; =0.005), positive lymph nodes (=0.021), and positive PD-L1 on TIICs (=0.010) were independent predictors of tumor recurrence. The 2- and 3-year RFS rates were 67.7% and 64.2% in negative PD-L1 on TIICs, while 27.8% and 22.3% in positive PD-L1 on TIICs, respectively.
Positive PD-L1 on TIICs was significantly associated with poorer RFS in "high-risk" patients after RC without AC. Our results support the use of adjuvant immunotherapy in "high-risk" patients with positive PD-L1 on TIICs after RC.
本研究旨在探讨程序性死亡配体-1（PD-L1）对膀胱癌（BCa）根治性膀胱切除术（RC）术后患者肿瘤浸润免疫细胞（TIICs）的预后作用。
我们回顾性分析了2014年4月至2019年12月期间92例接受BCa根治性膀胱切除术且未接受辅助化疗（AC）的“高危”（≥pT3a和/或pN+）患者。仅使用VENTANA（SP-142）免疫组织化学检测法检测TIICs上的PD-L1。根据TIICs上PD-L1覆盖的肿瘤面积百分比将患者分为三组：IC0（<1%）、IC1（≥1%且<5%）和IC2/3（≥5%）。PD-L1阳性定义为IC2/3（≥5%）。采用Kaplan-Meier生存分析来描述无复发生存期（RFS），并使用Cox比例风险模型来确定肿瘤复发的预测因素。
在该队列中，PD-L1 IC0、IC1和IC2/3的比例分别为21.7%、23.9%和54.4%。在随访（平均31.3个月）时，49例患者（53.3%）出现肿瘤复发。通过多变量分析，肿瘤分期（pT4；=0.005）、阳性淋巴结（=0.021）和TIICs上的PD-L1阳性（=0.010）是肿瘤复发的独立预测因素。TIICs上PD-L1阴性患者的2年和3年无复发生存率分别为67.7%和64.2%，而TIICs上PD-L1阳性患者的2年和3年无复发生存率分别为27.8%和22.3%。
TIICs上的PD-L1阳性与未接受AC的“高危”患者较差的无复发生存率显著相关。我们的结果支持对RC术后TIICs上PD-L1阳性的“高危”患者使用辅助免疫治疗。
