Abstract
BackgroundUrothelial carcinoma ranks the ninth among malignant cancers. We conducted this study to identify which patients could benefit more from the treatment of programmed death-1 (PD–1)/programmed death-ligand1 (PD–L1) inhibitors.Materials and MethodsWe performed literature searches, combined data from qualified literature and performed comparative analyses on the effectiveness of anti-PD–1/PD–L1 antibodies in patients with different PD–L1 expression levels.ResultsWe divided patients into three groups according to the percentages of PD–L1-positive cells, namely the low- PD-L1 (PD-L1 < 1%), the medium-PD-L1 (PD-L1 ≥ 1 and < 5%) and the high–PD–L1 (PD-L1 ≥ 5%) groups. We found that the high-PD-L1 group responded significantly better than other groups (P = 0.0003, ORs = 0.45, 95%CI: 0.29-071; P = 0.0009, ORs = 0.43, 95%CI: 0.25-0.73, for low-PD-L1 and medium-PD-L1 groups, respectively), while the latter two groups responded similarly (P = 0.90, ORs = 1.06, 95%CI: 0.62-1.83) to both PD–1 and PD–L1 inhibitors. Furthermore, we found that the medium-PD–L1 and high-PD–L1 groups responded similarly to PD-1/ PD-L1 inhibitors (P = 0.65, ORs = 1.11, 95%CI: 0.69–1.77), while the low-PD–L1 group responded better to PD-1 inhibitors than PD-L1 inhibitors (P = 0.046, ORs = 1.92, 95%CI: 0.98–3.89).ConclusionsOur results suggest that PD–L1 positive patients should be defined as those with ≥ 5% or greaterPD-L1-positive cells. PD-1 antibodies performed better only in the low-group patients, likely because they could block the interactions of PD–1 with both PD–L1 and PD–L2.
Highlights
The incidence of urothelial carcinoma has become the ninth of all malignant tumors and the first in urinary tract cancers [1]
We found that the high-PD-L1 group responded significantly better than other groups (P = 0.0003, Odds ratio (OR) = 0.45, 95% confidence interval (95%CI): 0.29-071; P = 0.0009, ORs = 0.43, 95%CI: 0.25-0.73, for low-PD-L1 and medium-PD-L1 groups, respectively), while the latter two groups responded (P = 0.90, ORs = 1.06, 95%CI: 0.62-1.83) to both programmed death-1 (PD–1) and programmed death-ligand1 (PD–L1) inhibitors
We found that the medium-PD–L1 and high-PD–L1 groups responded to PD-1/ PD-L1 inhibitors (P = 0.65, ORs = 1.11, 95%CI: 0.69–1.77), while the low-PD–L1 group responded better to PD-1 inhibitors than PD-L1 inhibitors (P = 0.046, ORs = 1.92, 95%CI: 0.98–3.89)
Summary
The incidence of urothelial carcinoma has become the ninth of all malignant tumors and the first in urinary tract cancers [1]. It leads to the death of more than 165,000 people every year all over the world [2]. Urothelial cancer can be divided into two groups: upper tract urothelial carcinoma and urinary bladder carcinoma. Both of the them occur more often in males than in females [3]. Urothelial carcinoma ranks the ninth among malignant cancers. We conducted this study to identify which patients could benefit more from the treatment of programmed death-1 (PD–1)/programmed death-ligand (PD–L1) inhibitors
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