The following article is part of conference coverage from the 2017 American Urological Association meeting in Boston. Renal and Urology News’ staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2017. 

BOSTON — Bladder cancer surgery patients with post-chemotherapy programmed cell death ligand-1 (PD-L1) expression have worse survival, according to researchers at the American Urological Association meeting.

Yasuhiro Hashimoto, MD, and colleagues of Hirosaki University in Hirosaki, Japan, conducted an immunohistochemical examination of PD-L1 expression in 102 bladder cancer patients (mean age 60 years; 81% men) following radical cystectomy. The investigators opted for the SP142 assay, which uses rabbit monoclonal anti-PD-L1 clone SP142 to assess PD-L1 protein at diagnostic levels of intensity of 0, 1, or 2.

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Over nearly 5 years of follow up, 41.1% of patients had cancer recurrence and 33.3% died. At 5 years, the disease-free survival (DFS) and cancer-specific survival (CSS) rates for the entire cohort were 59.7% and 66.6%, respectively.

A subset of 64.8% patients had neoadjuvant chemotherapy before cystectomy. In the neoadjuvant chemotherapy group, 5-year DFS was significantly lower for patients with PD-L1 expression: 31.7% vs 65.0%. Five-year CSS also was significantly lower for PD-L1 positive vs negative patients: 48.1% vs 69.6%.

“Despite the small study size, our data suggest that post-chemotherapy PD-L1 expression is associated with poor prognosis in bladder cancer patients receiving neoadjuvant chemotherapy and treated with cystectomy,” Dr Hashimoto told Renal & Urology News. “The results outline the importance of checking bladder cancer specimens from every patient for PD-L1 expression. In today’s era of immunotherapy, it seems reasonable that anti-PD-L1 immunotherapy is conducted alongside adjuvant therapy for recurrent disease in bladder cancer patients.”

The vast majority of bladder cancer patients in the study had urothelial carcinoma (89.2%). The remainder had squamous cell carcinoma (3.9%), squamous cell more than urothelial carcinoma (5.8%), or adenocarcinoma (0.9%). Most cancers (86.2%) were high grade. More than half of patients had pT2 or lower disease (55.8%), 24.5% pT3, and 19.6% pT4. A total of 8.8% had lymph node metastasis.

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Hashimoto Y, Murasawa H, Iwamura H, et al. Post-chemotherapy PD-L1 expression correlates with clinical outcomes in Japanese bladder cancer patients treated with total cystectomy. [abstract] J Urol 2017;197(4S):e427-e428. Poster presented at the American Urological Association 2017 annual meeting on May 13, 2017. Poster MP34-04.