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  • Clinicopathological and prognostic values of PD-L1 expression in oesophageal squamous cell carcinoma: a meta-analysis of 31 studies with 5368 patients

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Clinicopathological and prognostic values of PD-L1 expression in oesophageal squamous cell carcinoma: a meta-analysis of 31 studies with 5368 patients
  1. Zhen Liu1,2,
  2. Li Sun3,
  3. Lei Cai4,
  4. Man Guo5,
  5. Guanghui Xu5,
  6. Shushang Liu5,
  7. Gaozan Zheng5,
  8. Qiao Wang5,
  9. Xiao Lian4,
  10. Fan Feng5,
  11. Hongwei Zhang6
  1. 1 Department of General Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
  2. 2 Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
  3. 3 Department of Digestive Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, People's Republic of China
  4. 4 Department of Digestive Surgery, Xi’an International Medical Center, Xi'an, Shaanxi, People's Republic of China
  5. 5 Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Air Force Medical University, Xi’an, Shaanxi, People's Republic of China
  6. 6 Digestive Diseases Center, Wuxi Mingci Hospital, Wuxi, Jiangsu, People's Republic of China
  1. Correspondence to Professor Fan Feng, The Air Force Medical University, Xi’an, China; surgeonfengfan{at}163.com; Professor Hongwei Zhang, Digestive Diseases Center, Wuxi Mingci Hospital, Wuxi, Jiangsu, People's Republic of China; zhanghwfmmu{at}126.com

Abstract

Several immune checkpoint inhibitors targeting programmed death ligand 1 (PD-L1)/programmed death 1 have successfully improved the prognosis of oesophageal squamous cell carcinoma (ESCC) with approval in certain countries. However, whether the expression of PD-L1 is associated with the degree of benefit is unclear yet and a unified standard of antibody and cut-off value of PD-L1 detection is also lacking. The current meta-analysis then aimed to explore the association between PD-L1 expression and clinicopathological features as well as prognosis in ESCC.

A systematic search on PubMed, Embase, Cochrane Library and Web of Science databases was performed up to 30 March 2021. The correlation between PD-L1 expression and clinicopathological features, as well as prognosis in ESCC, was estimated with the random-effects model.

A total of 5368 patients from 31 retrospective studies were enrolled. The overexpression of PD-L1 was significantly associated with lymph node metastasis (OR 1.342, 95% CI 0.995 to 1.809, p=0.050) and distant metastasis (OR 1.516, 95% CI 1.001 to 2.294, p=0.050). The pooled HR showed that PD-L1 overexpression was significantly correlated with poor overall survival (OS) of patients with ESCC (HR 1.306, 95% CI 1.108 to 1.539, p<0.010) but not disease-free survival (DFS) (HR 1.180, 95% CI 0.937 to 1.487, p=0.160). Heterogeneity decreased significantly in subgroup analyses. The overexpression of PD-L1 was associated with poor DFS at the cut-off point of ≥1% (HR 1.642, 95% CI 1.367 to 1.973, p<0.010; I2=0%) and worse OS at the cut-off point of ≥10% (HR 1.575, 95% CI 1.175 to 2.111, p<0.010; I2=0%).

The overexpression of PD-L1 was correlated with lymph node and distant metastasis as well as poor survival of ESCC.

  • oesophageal disease
  • epidemiology
  • epidemiology
  • immunology

http://dx.doi.org/10.1136/postgradmedj-2021-140029

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    Footnotes

    • Contributors ZL, LS, LC and MG performed literature searching and extracted the data. ZL, GX and SL performed quality assessment. ZL, GZ, QW and XL analysed the data. ZL wrote the paper. HZ and FF conceived and designed this study. All authors reviewed the paper and read and approved the final manuscript.

    • Funding This study was supported in part by grants from the National Natural Scientific Foundation of China (numbers 81572306, 81772937, 81502403 and XJZT12Z03).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.