Xue Li1,2, Minghuan Li2, Zhen Lian1, Hui Zhu2, Li Kong2, Ping Wang1, Jinming Yu3,4. 1. Department of Radiation Oncology and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China. 2. Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, 250000, China. 3. Department of Radiation Oncology and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China. sdyjmdoctor@163.com. 4. Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, 250000, China. sdyjmdoctor@163.com.
Abstract
BACKGROUND: Cancer therapies that target the PD-1/PD-L1 pathway are in ongoing phase I/II clinical trials for several tumor types. However, the prognostic value of PD-L1 expression in breast cancer is unclear. OBJECTIVE: We assessed the prognostic role of PD-L1 expression in breast cancer. METHODS: We searched Medline/PubMed for eligible studies of the association between PD-L1 expression and patient survival in breast cancer published before 7 December 2015. The effect size was the hazard ratio (HR) with 95 % confidence interval (CI) for overall survival (OS), recurrence-free survival (RFS) and metastasis-free survival (MFS). Odds ratios (OR) with 95 % CIs were also extracted to evaluate associations between PD-L1 expression and patient clinicopathological features. RESULTS: We included five studies with 7,802 total patients in this meta-analysis. The pooled OR associated high PD-L1 expression with predictors of poor-prognosis: high tumor grade, negative ER status, negative PR status, positive HER2 status and lymphovascular invasion. High PD-L1 protein expression was associated with shorter OS (HR = 3.22, 95 % CI: 1.86-5.59; P < 0.0001), shorter RFS (HR = 1.38, 95 % CI: 1.03-1.86; P = 0.03) and shorter MFS (HR = 3.33, 95 % CI: 2.30-4.82; P < 0.00001); whereas high PD-L1 mRNA expression was associated with longer OS (HR = 0.86, 95 % CI: 0.75-1.00; P = 0.05) and longer RFS (HR = 0.57, 95 % CI: 0.36-0.91; P = 0.02). LIMITATIONS: The findings of these studies were significantly heterogeneous; the results should be interpreted cautiously. CONCLUSION: In breast cancer, high PD-L1 protein expression appears to be a negative prognostic factor, whereas high PD-L1 mRNA expression appears to be a favorable prognostic factor.
BACKGROUND: Cancer therapies that target the PD-1/PD-L1 pathway are in ongoing phase I/II clinical trials for several tumor types. However, the prognostic value of PD-L1 expression in breast cancer is unclear. OBJECTIVE: We assessed the prognostic role of PD-L1 expression in breast cancer. METHODS: We searched Medline/PubMed for eligible studies of the association between PD-L1 expression and patient survival in breast cancer published before 7 December 2015. The effect size was the hazard ratio (HR) with 95 % confidence interval (CI) for overall survival (OS), recurrence-free survival (RFS) and metastasis-free survival (MFS). Odds ratios (OR) with 95 % CIs were also extracted to evaluate associations between PD-L1 expression and patient clinicopathological features. RESULTS: We included five studies with 7,802 total patients in this meta-analysis. The pooled OR associated high PD-L1 expression with predictors of poor-prognosis: high tumor grade, negative ER status, negative PR status, positive HER2 status and lymphovascular invasion. High PD-L1 protein expression was associated with shorter OS (HR = 3.22, 95 % CI: 1.86-5.59; P < 0.0001), shorter RFS (HR = 1.38, 95 % CI: 1.03-1.86; P = 0.03) and shorter MFS (HR = 3.33, 95 % CI: 2.30-4.82; P < 0.00001); whereas high PD-L1 mRNA expression was associated with longer OS (HR = 0.86, 95 % CI: 0.75-1.00; P = 0.05) and longer RFS (HR = 0.57, 95 % CI: 0.36-0.91; P = 0.02). LIMITATIONS: The findings of these studies were significantly heterogeneous; the results should be interpreted cautiously. CONCLUSION: In breast cancer, high PD-L1 protein expression appears to be a negative prognostic factor, whereas high PD-L1 mRNA expression appears to be a favorable prognostic factor.
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