Immunohistochemical Expression of PD-L1 in Urothelial Carcinoma and its Association with Clinicopathological Parameters

Background: Bladder cancer (BC) is considered the ninth most frequent cancer worldwide. In Egypt, bladder cancer speaks to 6.9% in both genders. Urothelial carcinoma (UC) is the most common histological subtype of bladder cancer. Patients who are diagnosed with muscle-invasive UC often undergo disease progression or metastasis despite forceful procedures like radical cystectomy and systemic chemotherapy. Multiple studies showed that PD-L1 provides a practical and rapid attempt that may help guide therapeutic decision-making. Aim: This study aimed to assess PD-L1 expression in UC and its role as a prognostic factor of UC in a 5-year survival rate. Methods: This analytical cross-sectional study was done in the Pathology department of the Faculty of Medicine at Suez Canal University. Forty-four UC specimens were analyzed for immunohistochemical expression of PD-L1 and its role in prognosis. Results: The age of the forty-four cases participating in this study extends from 45 to 85 years and the most common age category ranges from 60-69 years, representing 40.9%. The predominant sex was male representing 79.5 %. PD-L1 expression was positive in 59.10% of the patients whereas 40.90% of the cases had negative results. The tumor showed significant association with grading, lymphovascular invasion, perineural invasion, and staging. By following up on the cases and assessing the prognosis of the disease, it was found that 72.2% of the cases died, 11.4% had tumor recurrence, 9.1% had tumor metastasis and only 6.8% of the cases improved and under follow-up. Conclusions: This study provides that PDL1 expression is present in a significant proportion of urothelial cancer cases and is associated with aggressive tumor characteristics. Although, no significant correlation was found between PD-L1 and clinical outcomes. These results suggest that anti-PD-L1 immunotherapy may be a promising treatment for patients with higher-grade tumors and pathological stages and a useful prognostic factor.