Institute of Pathology, University Hospital Erlangen-Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
Adv Anat Pathol. 2023 May 1;30(3):203-210. doi: 10.1097/PAP.0000000000000383. Epub 2022 Nov 22.
Genitourinary malignancies include a broad spectrum of distinct tumor entities occurring in the kidney, the urinary tract, the prostate, the adrenal glands, the penis, and testicles. Each tumor entity presents with unique biological characteristics, especially in terms of immunobiology. The immune landscape of genitourinary malignancies differs between immunoreactive tumors like urothelial carcinoma or carcinomas of the kidney, for which several immunotherapeutic treatment options have been approved in the past years. In contrast, prostate cancer presents with low immunogenicity and previous trials exploring immune checkpoint inhibitors and other immunotherapeutic agents did not proof substantial survival benefits. In this review, we are presenting a streamlined overview on the role of surgical pathologists within the contemporary practice of immune oncology. It includes current indications for pathologic programmed death-ligand 1 (PD-L1) assessment and important pathologic considerations on PD-L1 testing harmonization including interassay and algorithm variabilities. In addition, we will discuss emerging biomarkers beyond PD-L1 and their potential to predict immunotherapy responses including tumor mutational burden, microsatellite instability, gene expression signatures, and histologic factors.
泌尿生殖系统恶性肿瘤包括广泛的不同肿瘤实体，发生在肾脏、泌尿道、前列腺、肾上腺、阴茎和睾丸。每种肿瘤实体都具有独特的生物学特征，尤其是在免疫生物学方面。泌尿生殖系统恶性肿瘤的免疫景观在免疫反应性肿瘤（如尿路上皮癌或肾癌）之间存在差异，过去几年已经批准了几种免疫治疗选择。相比之下，前列腺癌的免疫原性较低，之前探索免疫检查点抑制剂和其他免疫治疗药物的试验并未证明有实质性的生存获益。在这篇综述中，我们将简要介绍外科病理学家在当代免疫肿瘤学实践中的作用。它包括当前病理程序性死亡配体 1（PD-L1）评估的适应证，以及 PD-L1 检测协调的重要病理考虑因素，包括检测间和算法变异性。此外，我们将讨论 PD-L1 以外的新兴生物标志物及其预测免疫治疗反应的潜力，包括肿瘤突变负担、微卫星不稳定性、基因表达谱和组织学因素。
