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Iacovelli, Roberto; Nolè, Franco; Verri, Elena; Renne, Giuseppe; Paglino, Chiara; Santoni, Matteo; Cossu Rocca, Maria; Giglione, Palma; Aurilio, Gaetano; Cullurà, Daniela; Cascinu, Stefano; Porta, Camillo
Targeted oncology, 04/2016, Letnik: 11, Številka: 2Journal Article
Background Several clinical trials have reported that therapies targeting programmed death-1 (PD1) and its ligand (PD-L1) improve patient outcomes, while tumor response has been related to PD-L1 expression. Objective To investigate the prognostic role of PD-L1 expression in patients affected by renal cell carcinoma (RCC). Methods MEDLINE/PubMed, the Cochrane Library, and ASCO University were searched for studies investigating the prognostic role of PD-L1 expression in RCC. Data extraction was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Six studies and 1323 cases were included in the final analysis. PD-L1 was expressed in 24.2 % of clear cell tumors compared to 10.9 % of non-clear cell tumors ( p = 0.002). In the overall population, a higher level of PD-L1 expression increased the risk of death by 81 % (HR; 1.81, 95 % CI 1.31–2.49; p < 0.001). When the analysis was restricted to cases evaluated by immunohistochemistry alone, the higher expression of PD-L1 more than doubled the risk of death (HR; 2.05, 95 % CI 1.38–3.05; p < 0.001). In clear cell histology, higher PD-L1 expression increased the risk of death by 53 % (HR; 1.53, 95 % CI 1.27–1.84; p < 0.001), while in metastatic patients, the evaluation of PD-L1 expression on primary tumors revealed that it retains its prognostic role (HR; 1.45, 95 % CI 1.08–1.93; p = 0.01). Limitations Significant heterogeneity has been identified among the included studies. As a consequence, cautious interpretation of the results is recommended. Conclusion This meta-analysis indicates that a higher level of PD-L1 expression is a negative prognostic factor in RCC. Its validation as an independent prognostic factor compared to other traditionally used clinical parameters in localized or advanced disease is recommended.
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