Role of Programmed Cell Death Ligand-1 Expression on Prognostic and Overall Survival of Breast Cancer: A Systematic Review and Meta-analysis

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2019 Apr 23

PMID 31008945

Citations 14

Authors

Shichao Li

Li Chen

Jun Jiang

Affiliations

Soon will be listed here.

Abstract

Background: Recently, the correlation of immunological checkpoint marker programmed cell death ligand-1 (PD-L1) and the prognosis of various cancers has been a research hotspot. The aim of this study is to examine the prognostic effect of PD-L1 in breast cancer.

Methods: PubMed, EMBASE, Web of Science, the Cochrane Library database were searched for eligible studies and additional hand-searching were reviewed as an augmentation. Pooled hazard ratios (HR) and 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS)/recurrence-free survival (RFS), and metastasis-free survival (MFS) were estimated using fixed- or random-effect models.

Results: Data from 19 studies involving 12,505 patients were collected. Study quality was assessed according to guidelines for assessing quality in prognostic studies. PD-L1 expression was significantly associated with lymph node metastasis (P < .001), high tumor grade (P < .001), negative hormone receptor (P < .001), human epidermal growth factor receptor 2 (HER2) positivity (P < .001), high Ki67 (P < .001), and high tumor-infiltrating lymphocytes (TILs) (P < .001). PD-L1 expression had no significant impact on CSS (pooled HR 0.83, 95% CI = 0.64-1.09, P = .19) or MFS (pooled HR 1.11, 95% CI = 0.62-1.97, P = .72), but significantly correlated with shortened OS (pooled HR 1.52, 95% CI = 1.14-2.03, P = .004) and DFS (pooled HR 1.31, 95% CI = 1.14-1.51, P < .000). Subgroup analysis showed that not PD-L1 RNA expression, but protein expression was associated with shorter survival, in addition, the adverse prognostic effect of PD-L1 expression remained in luminal A, luminal B, and HER2 subtype, not in basal-like or triple-negative subtype.

Conclusions: An elevated PD-L1 expression significantly correlates with high-risk prognostic indicators and decreased survival in patients with breast cancer.

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