Prognostic Value of PD-L1 and Its Correlation with GATA3, CK5/6, and CK14 Expression in Muscle-Invasive Bladder Cancer.
Abstract
Background
Muscle-invasive bladder cancer (MIBC) is an aggressive urothelial carcinoma with poor outcomes. This study investigated programmed death ligand 1 (PD-L1) expression and its association with key immunohistochemical markers (GATA3, CK5/6, CK14) and overall survival (OS).
Methods
We analyzed formalin-fixed, paraffin-embedded tissue from 61 patients with MIBC who underwent radical cystectomy and chemoradiation. Immunohistochemistry was performed for PD-1, PD-L1 (SP263), GATA3, CK5/6, and CK14. PD-L1 expression was classified as high or low based on VENTANA guidelines.
Results
PD-L1 was detected in 34% of tumor tissues and 79% of peritumoral immune cells. High PD-L1 expression (18% of cases) was significantly associated with advanced tumor stage, lymphovascular invasion, metastasis, and poor outcomes. Patients with high PD-L1 had markedly reduced 2-year OS (18.2% vs. 57.2%; HR: 3.16, 95% CI: 1.59-7.24). A negative correlation was observed between PD-L1 and GATA3, while PD-L1 overexpression positively correlated with basal-like markers CK5/6 and CK14.
Conclusion
High PD-L1 expression predicts aggressive clinicopathological features and poor survival in MIBC. Routine PD-L1 assessment, alongside luminal and basal markers, offers a critical strategy for refining risk stratification and guiding personalized therapeutic decisions in patients undergoing radical cystectomy.