Document Type : Research Articles
Authors
1
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
2
Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
3
Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
4
Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
5
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
6
Faculty of Medical Technology, Medical Technology Service Center, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
7
International Center of Excellence in Seafood Science and Innovation, Faculty of Agro-Industry, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
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.
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