Programmed death-ligand 1 (PD-L1) positivity is associated with poor prognosis in renal cell carcinoma (RCC). Because the prognostic impact and effect of confounding factors are less known, we investigated the prognostic significance of PD-L1 expression in Japanese patients with recurrent/metastatic RCC who started systemic therapy in 2010-2015.
This multicenter, retrospective study recruited patients from 29 Japanese study sites who had prior systemic therapy for RCC (November 2018 to April 2019) and stored formalin-fixed paraffin-embedded primary lesion samples. The primary outcome was overall survival (OS) by PD-L1 expression. Secondary outcomes included OS in subgroups and duration of first- and second-line therapies by PD-L1 expression. OS distributions were estimated using Kaplan-Meier methodology.
PD-L1 expression (on immune cells [IC] ≥ 1%) was observed in 315/770 (40.9%) patients. PD-L1 positivity was more prevalent in patients with poor risk per both Memorial Sloan Kettering Cancer Center [MSKCC] and International Metastatic RCC Database Consortium, and high-risk pathological features (higher clinical stage, nuclear grade and sarcomatoid features). Median OS for PD-L1-positive patients was 30.9 months (95% CI 25.5-35.7) versus 37.5 months (95% CI 34.0-42.6) for PD-L1-negative patients (HR 1.04 [90% CI 0.89-1.22, p = 0.65]; stratified by MSKCC risk and liver metastases). Propensity score weight (PSW)-adjusted OS was similar between PD-L1-positive and -negative patients (median 34.4 versus 31.5 months; estimated PSW-adjusted HR 0.986).
This study suggests PD-L1 status was not an independent prognostic factor in recurrent/metastatic RCC during the study period because PD-L1 positivity was associated with poor prognostic factors, especially MSKCC risk status.
International journal of clinical oncology. 2021 Jul 21 [Epub ahead of print]
Motohide Uemura, Noboru Nakaigawa, Naoto Sassa, Katsunori Tatsugami, Kenichi Harada, Toshinari Yamasaki, Nobuaki Matsubara, Takuya Yoshimoto, Yuki Nakagawa, Tamaki Fukuyama, Mototsugu Oya, Nobuo Shinohara, Hirotsugu Uemura, Toyonori Tsuzuki
Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan., Department of Urology, Yokohama City University Graduate School of Medicine, 22-2 Seto, Kanazawa Ward, Yokohama, Kanagawa, 236-0027, Japan., Department of Urology, Nagoya University Graduate School of Medicine, Furocho, Chikusa Ward, Nagoya, Aichi, 464-8601, Japan., Department of Urology, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan., Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Yoshidakonoecho, Sakyo Ward, Kyoto, 606-8501, Japan., Department of Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan., Biometrics Department, Chugai Pharmaceutical Co., Ltd., Nihonbashi Muromachi 2-1-1, Chuo City, Tokyo, 103-8324, Japan., Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Nihonbashi Muromachi 2-1-1, Chuo City, Tokyo, 103-8324, Japan., Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, 160-8582, Japan., Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan., Department of Urology, Kindai University, Faculty of Medicine, 377-2 Ohnohigashi, Osaka-Sayama City, Osaka, 589-8511, Japan. ., Department of Surgical Pathology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.