Prognostic Value of Programmed Cell Death Ligand-1 Expression in Nasopharyngeal Carcinoma: A Meta-Analysis of 1,315 Patients

Abstract

Background: The prognostic value of programmed cell death ligand-1 (PD-L1) in patients with nasopharyngeal carcinoma (NPC) remains controversial. Therefore, we conducted this meta-analysis to understand the role of PD-L1 in NPC. Method: We searched PubMed, Embase, Web of Science, and Cochrane Library up to April 2019. We determined the pooled hazard ratio (HR) and 95% confidence intervals (CIs) to assess the relationship between PD-L1 and various survival outcomes. Begg's funnel plot was used to assess any publication bias. Results: Eleven studies involving 1,315 patients were included in this meta-analysis. For overall survival (OS), the HR was 1.48 and 95% CI was 1.00-2.18 (p = 0.049). For disease-free survival (DFS), the HR was 1.51 and 95% CI was 0.85-2.69 (p = 0.162). For distant metastasis-free survival (DMFS), the HR was 1.75 and 95% CI was 0.64-4.79 (p = 0.277). For local recurrence-free survival (LRFS), the HR was 0.67 and 95% CI was 0.06-8.16 (p = 0.756). The results of prognosis of PD-L1 and OS were more significant after sensitivity analysis. The pooled odds ratio indicated that PD-L1 expression was not associated with T stage, N stage, M stage, overall stage, sex, age, smoking, or alcohol intake. No publication bias was found. Conclusion: Our meta-analysis showed that PD-L1 overexpression in NPC was associated with a poor OS and may be useful as a novel prognostic factor for NPC.

Keywords: PD-L1; clinical use; meta-analysis; nasopharyngeal carcinoma; prognosis.

Figure 1

Flowchart of study selection.

Figure 2

Forest plot diagrams of hazard ratios for correlations between PD-L1 expression and (A) OS, (B) DFS, (C) DMFS, and (D) LRFS.

Figure 3

Sensitivity analysis for (A) OS, (B) DFS, (C) DMFS, and (D) LRFS.

Figure 4

Funnel plots for publication bias of (A) OS, (B) DFS, (C) DMFS, and (D) LRFS.