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Review
. 2021 Dec 3;13(23):6090.
doi: 10.3390/cancers13236090.

Prognostic Role of PD-L1 Expression in Invasive Breast Cancer: A Systematic Review and Meta-Analysis

Magno Belém Cirqueira  1 , Carolina Rodrigues Mendonça  1 , Matias Noll  1   2   3 , Leonardo Ribeiro Soares  4 , Maria Auxiliadora de Paula Carneiro Cysneiros  1 , Regis Resende Paulinelli  3 , Marise Amaral Rebouças Moreira  1 , Ruffo Freitas-Junior  4
Affiliations
Review

Prognostic Role of PD-L1 Expression in Invasive Breast Cancer: A Systematic Review and Meta-Analysis

Magno Belém Cirqueira et al. Cancers (Basel). .

Abstract

Programmed death ligand 1 (PD-L1) has been investigated in various types of cancer; however, the role of PD-L1 expression in breast cancer remains controversial. We performed a systematic review and meta-analysis to assess the association of PD-L1 expression with clinicopathological variables, overall survival (OS), and disease-free survival (DFS) in invasive breast cancer. A total of 965 articles were included from CINAHL, Embase, PubMed, and Scopus databases. Of these, 22 studies encompassing 6468 cases of invasive breast cancer were included in the systematic review, and 15 articles were included in the meta-analysis. PD-L1 expression was associated with age ≥ 50 years, lymph node status-negative, progesterone receptor-negative, Ki67 ≥ 20%, and human epidermal growth factor receptor 2 (HER2)-negative. PD-L1 positivity was associated with worse OS (hazard ratio, HR, 2.39; 95% confidence interval, CI, 1.26-3.52; p =< 0.000); however, there was no significant improvement in DFS (HR 0.17; 95% CI -0.12-0.46; p =< 0.252). PD-L1 positivity was significantly associated with the clinicopathological characteristics of favorable and unfavorable prognoses. However, the final clinical outcome was associated with lower OS and had no significant association with DFS.

Keywords: PD-L1; breast cancer; immunohistochemistry; prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Forest plot of the proportion (%) of PD-L1 expression in tumor cells, immune cells, and both tumor and immune cells.
Figure 3
Figure 3
Forest plots of hazard ratios (HRs) for the effect of PD-L1 upregulation on overall survival (OS).
Figure 4
Figure 4
Forest plots of hazard ratios (HRs) for the effect of PD-L1 upregulation on disease-free survival (DFS).
Figure 5
Figure 5
Quality plot graphically representing the risk of bias (RoB) analysis. The most relevant sources of bias were assessed in primary-level studies using the Quality in Prognosis Studies (QUIPS) tool.
Figure 6
Figure 6
Funnel plot for the studies included in the meta-analysis.
See this image and copyright information in PMC

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