AUA 2017: Prognostic Value of PD-1 and PD-L1 Expression in Patients with High-Grade Urothelial Carcinoma of the Upper Urinary Tract

Boston, MA ( Dr. Krabbe and colleagues from UT Southwestern presented their analysis of assessing the PD-1/PD-L1 expression in patients with high-grade upper tract urothelial carcinoma (UTUC) at this morning’s UTUC poster session at the 2017 AUA Annual meeting. This work specific to upper urinary tract tumors is important considering that historically systemic treatments used in bladder urothelial carcinoma are extrapolated to UTUC.

To do this study, the authors created 448 microarrays from patients in the International UTUC collaboration who underwent extirpative surgery for high-grade UTUC. These microarrays were then stained for PD-1 and PD-L1 expression and correlated with oncologic outcomes. PD-L1 and PD-1 were positive in 24% and 38% of patients, respectively. PD-L1 positivity was not significantly associated with survival outcomes. However, on Cox regression univariate modelling, PD-1 positivity was associated with worse recurrence-free survival (RFS) (HR 1.5, 95%CI 1.08-2.14), cancer-specific survival (CSS) (HR 1.5, 95%CI 1.07-2.19), and overall survival (OS) (HR 1.5, 95%CI 1.10-1.97). On Cox regression multivariate modelling, PD-1 positivity was no longer found to be an independent predictor of RFS, CSS or OS. A strength of this study is the large sample size allowing appropriate survival analysis for this relatively rare tumor entity.

In summary, the authors have identified PD-1 positivity associations with adverse pathological criteria and as a significant prognosticator for RFS, CSS and OS on univariate analysis in patients treated with extirpative surgery for high-grade UTUC in a large, multi-institutional cohort. This is exciting research potentially demonstrating feasibility of immunotherapy in the neo-/adjuvant and metastatic setting for UTUC.

Presented by: Laura-Maria Krabbe, UT Southwestern Medical Center, Dallas, TX, USA

Co-Authors: Barabara Heitzplatz, Ryan Hutchinson, Solomon Woldu, Nirmish Singla, Sina Preuss, Martin Boegemann, Christopher Wood, Jose Karam, Alon Weizer, Jay Raman, Mesut Remzi, Nathalie Rioux-Leclercq, Andrea Haitel, Marco Roscigno, Christian Bolenz, Karim Bensalah, Arthur Sagalowsky, Shahrokh Shariat, Yair Lotan, Evanguelos Xylinas, Vitaly Margulis

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA