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Prognostic Role of Programmed Death Ligand-1 Expression in Breast Cancer: A Systematic Review and Meta-Analysis

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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.

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Authors and Affiliations

  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

    Xue Li, Zhen Lian, Ping Wang & Jinming Yu

  2. Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, 250000, China

    Xue Li, Minghuan Li, Hui Zhu, Li Kong & Jinming Yu

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  1. Xue Li
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Correspondence to Jinming Yu.

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Li, X., Li, M., Lian, Z. et al. Prognostic Role of Programmed Death Ligand-1 Expression in Breast Cancer: A Systematic Review and Meta-Analysis. Targ Oncol 11, 753–761 (2016). https://doi.org/10.1007/s11523-016-0451-8

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