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. 2021 Apr 28;11(5):404.
doi: 10.3390/life11050404.

PD-L1 Expression in Muscle Invasive Urothelial Carcinomas as Assessed via Immunohistochemistry: Correlations with Specific Clinical and Pathological Features, with Emphasis on Prognosis after Radical Cystectomy

Ioan Alin Nechifor-Boilă  1   2 , Andrada Loghin  3   4 , Adela Nechifor-Boilă  3   4 , Myriam Decaussin-Petrucci  5 , Septimiu Voidăzan  6 , Bogdan Călin Chibelean  2 , Orsolya Martha  2 , Angela Borda  3   7
Affiliations

PD-L1 Expression in Muscle Invasive Urothelial Carcinomas as Assessed via Immunohistochemistry: Correlations with Specific Clinical and Pathological Features, with Emphasis on Prognosis after Radical Cystectomy

Ioan Alin Nechifor-Boilă et al. Life (Basel). .

Abstract

In the present study, we analyzed Programmed Death Ligand-1 (PD-L1) expression in radical cystectomy (RC) specimens from patients with muscle-invasive urothelial carcinoma (UC), in order to assess any correlations with specific clinicopathological features and its potential prognostic value. A multi-institutional study was performed within the departments of urology and pathology at the Mureș County Hospital, Romania, and Centre Hospitalier Lyon Sud, France. Sixty-nine patients with MIBC were included, for whom tumor histology (conventional versus histological variant/differentiation), tumor extension (T), lymph node involvement (N), and distant metastases (M) were recorded. PD-L1 immunostaining was performed using the 22C3 clone and was interpreted using the combined positive score (CPS) as recommended (Dako Agilent, Santa Clara, CA, USA). Positive PD-L1 immunostaining was more prevalent among UCs with squamous differentiation compared to conventional UCs and trended towards an improved OS (p = 0.366). We found the T stage to be a risk factor for poor survival in PD-L1-positive patients (HR 2.9, p = 0.021), along with the N stage in PD-L1-negative patients (HR 1.98, p = 0.007). No other clinicopathological factor was found to be significantly associated with PD-L1 positivity. Thus, we confirm the need for PD-L1 immunostaining prior to initiating immune checkpoint inhibitor therapy for a more accurate assessment of the patients' chances of responding to treatment.

Keywords: immune checkpoint inhibitors; lymphatic node status overall survival; muscle-invasive bladder cancer; tumor stage.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Representative examples of urothelial carcinoma cases (HE staining left) with a positive 22C3 PD-L1 status (right). (A,B) A case of urothelial carcinoma with squamous differentiation demonstrating moderate to intense, partial or complete membrane PD-L1 expression in most of the tumor cells, and a clumpy, less intense, cytoplasmic ± membrane positivity in the immune cells; the CPS for this case was set at 50. (C,D) A case of sarcomatoid variant urothelial carcinoma, revealing an intense, complete PD-L1 membrane positivity in all tumor cells; the CPS for this case was set at 100. (E,F) A case of conventional urothelial carcinoma showing complete membrane expression in the tumor cells and a clumpy, less intense, cytoplasmic ± membrane pattern of expression in the immune cells; the CPS for this case was set at 80.
Figure 2
Figure 2
Kaplan-Meier plots for overall survival showing that patients with urothelial carcinoma and a positive PD-L1 status (orange line) had improved overall survival versus patients with urothelial carcinoma and a negative PD-L1 status (blue line).
See this image and copyright information in PMC

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