Abstract
Background: The prognostic role of programmed cell death-ligand 1 (PD-L1) in bladder cancer has been investigated in previous studies, but the results remain inconclusive. Therefore, we carried out a meta-analysis to evaluate the prognostic significance of PD-L1 in patients with bladder cancer. Methods: The electronic databases PubMed, Embase, Web of Science, and Cochrane Library were searched. The association between PD-L1 expression and survival outcomes and clinicopathological factors was analyzed by hazard ratios (HRs) or odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 11 studies containing 1,697 patients were included in the meta-analysis. High PD-L1 expression was associated with poor overall survival (OS) (HR = 1.83, 95% CI = 1.24–2.71, p = 0.002). There was nonsignificant association between PD-L1 and recurrence-free survival (RFS) (HR = 1.43, 95% CI = 0.89–2.29, p = 0.134), cancer-specific survival (CSS) (HR = 1.51, 95% CI = 0.80–2.87, p = 0.203), or disease-free survival (DFS) (HR = 1.53, 95% CI = 0.88–2.65, p = 0.13). Furthermore, high PD-L1 was significantly correlated with higher tumor stage (OR = 3.9, 95% CI = 2.71–5.61, p < 0.001) and distant metastasis (OR = 2.5, 95% CI = 1.22–5.1, p = 0.012), while PD-L1 overexpression was not correlated with sex, tumor grade, lymph node status, and multifocality. Conclusions: The meta-analysis suggested that PD-L1 overexpression could predict worse survival outcomes in bladder cancer. High PD-L1 expression may act as a potential prognostic marker for patients with bladder cancer.
Highlights
Bladder cancer is the most common malignancy of the urinary tract, accounting for 80,470 new cases and 17,670 deaths in 2019 alone in the United States (Siegel et al, 2019)
Thirty-seven studies were screened by full-text examination, and 26 studies were excluded for following reasons: 20 studies did not provide sufficient for analysis, 2 studies recruited overlapped patients, 2 studies were reviews, 1 study did not focus on programmed cell death-ligand 1 (PD-L1), and 1 study did not use IHC method for PD-L1 detection
The pooled data demonstrated that high PD-L1 was significantly correlated with higher tumor stage (OR = 3.9, 95% confidence intervals (CIs) = 2.71–5.61, p < 0.001) and distant metastasis (OR = 2.5, 95% CI = 1.22–5.1, p = 0.012)
Summary
Bladder cancer is the most common malignancy of the urinary tract, accounting for 80,470 new cases and 17,670 deaths in 2019 alone in the United States (Siegel et al, 2019). Up to 75% of patients present with non-muscle-invasive bladder cancer (NMIBC), about 20% present with muscle-invasive bladder cancer (MIBC), and 5% would have metastatic disease. Many studies (Nakanishi et al, 2007; Boorjian et al, 2008; Wang et al, 2009; Xylinas et al, 2014; Bellmunt et al, 2015; Wu et al, 2016; Noro et al, 2017; Li et al, 2018b; Pichler et al, 2018; Owyong et al, 2019; Wang et al, 2019) investigated the prognostic significance of PD-L1 expression in bladder cancer, but the results remain controversial. The prognostic role of programmed cell death-ligand 1 (PD-L1) in bladder cancer has been investigated in previous studies, but the results remain inconclusive. We carried out a meta-analysis to evaluate the prognostic significance of PD-L1 in patients with bladder cancer
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