ORIGINAL ARTICLE
Status of PD-1 and PD-L1 expression in invasive urothelial carcinoma of the bladder with mismatch repair protein deficiency
More details
Hide details
1
Department of Pathology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
2
Department of Pathology, Ankara City Hospital, Ankara, Turkey
Submission date: 2023-04-20
Final revision date: 2023-06-16
Acceptance date: 2023-07-26
Publication date: 2023-10-25
Corresponding author
Nuran Sungu
Nuran Sungu
Department of Pathology,
Faculty of Medicine,
Ankara Yıldırım Beyazıt University,
University District 1604. Street No: 9
Çankaya/Ankara, Turkey
Pol J Pathol 2023;74(3):161-170
KEYWORDS
TOPICS
ABSTRACT
It has been reported that mismatch repair deficient (d-MMR) tumors show sensitivity to immune checkpoint inhibitors. We aimed to evaluate the correlation of d-MMR and PD-1/PD-L1 expression in invasive urothelial carcinoma of the bladder. Tissue microarray (TMA) tissues were stained PD-1/PD-L1 and MMR proteins. The expression ratio of these markers has been compared with histopathologic parameters. d-MMR tumors were more superficial muscle invasive (p = 0.012). When the d-MMR, and PD-1/PD-L1 expression ratios were examined, a significant correlation was obtained between the d-MMR and PD-L1 expression ratio of > 5% in both the tumor and immune cells (p = 0.02 and p = 0.004, respectively). The expression ratio was higher in the patients without MMR loss. PD-1 and PD-L1expression in those with MSH6 loss was one or none. When PD1/PDL1 expression was compared with histopathological parameters, a significant relationship was observed between tumor grade and depth of muscle invasion. PD-L1 expression was not observed in the superficial muscle invasive tumors. This study was shown the status of d-MMR and PD-1/PD-L1 in invasive urothelial cancers and their correlation with prognostic markers. PD-1/PD-L1 expression may contribute to the progression and poor prognosis of bladder cancer. However, further studies are required to research the clinical utility.
REFERENCES (35)
1.
Vageli DP, Giannopoulos S, Doukas SG, et al. Mismatch repair hMSH2, hMLH1, hMSH6 and hPMS2 mRNA expression profiles in precancerous and cancerous urothelium. Oncol Lett 2013; 5: 283-294.
2.
Lindner AK, Schachtner G, Tulchiner G, et al. Lynch Syndrome: Its Impact on Urothelial Carcinoma. Int J Mol Sci 2021; 22: 531.
3.
Ligtenberg MJ, Kuiper RP, Geurts van Kessel A, Hoogerbrugge N. EPCAM deletion carriers constitute a unique subgroup of Lynch syndrome patients. Fam Cancer 2013; 12: 169-174. .
4.
Mangold E, Pagenstecher C, Friedl W, et al. Spectrum and frequencies of mutations in MSH2 and MLH1 identified in 1,721 German families suspected of hereditary nonpolyposis colorectal cancer. Int J Cancer 2005; 116: 692-702.
5.
Boland CR. Recent discoveries in the molecular genetics of Lynch syndrome. Fam Cancer 2016; 15: 395-403.
6.
Modrich, P. Mechanisms in eukaryotic mismatch repair. J Biol Chem 2006; 281: 30305-30309.
7.
Bridge G, Rashid S, Martin SA. DNA mismatch repair and oxidative DNA damage: Implications for cancer biology and treatment. Cancers 2014; 6: 1597–1614.
8.
Dominguez-Valentin M, Sampson JR, Seppälä TT, et al. Cancer risks by gene, age, and gender in 6350 carriers of pathogenic mismatch repair variants: Findings from the Prospective Lynch Syndrome Database. Genet Med 2020; 22: 15-25.
9.
Sobrino-Reig E, Meizoso T, García J, et al. Morphological predictors for microsatellite instability in urothelial carcinoma. Diagn Pathol 2021; 16: 106.
10.
Kawakami H, Zaanan A, Sinicrope FA. Microsatellite Instability Testing and Its Role in the Management of Colorectal Cancer. HHS Public Access 2016; 16: 1-14.
11.
Chintalacheruvu LM, Shaw T, Buddam A, et al. Major hereditary gastrointestinal cancer syndromes: a narrative review. J Gastrointest Liver Dis 2017; 26: 157-163.
12.
Buza N, Ziai J, Hui P. Mismatch repair deficiency testing in clinical practice. Expert Rev Mol Diagn 2016; 16: 591-604.
13.
Chen W, Swanson BJ, Frankel WL. Molecular genetics of microsatellite-unstable colorectal cancer for pathologists. Diagn Pathol 2017; 12: 24.
14.
Modica I, Soslow RA, Black D, et al. Utility of immunohistochemistry in predicting microsatellite instability in endometrial carcinoma. Am J Surg Pathol 2007; 31: 744-751.
15.
Hashmi AA, Mudassir G, Hashmi RN, et al. Microsatellite instability in endometrial carcinoma by immunohistochemistry, association with clinical and histopathologic parameters. Asian Pac J Cancer Prev 2019; 20: 2601-2606.
16.
Clarke BA, Cooper K. Identifying Lynch syndrome in patients with endometrial carcinoma shortcomings of morphologic and clinical schemas. Adv Anat Pathol 2012; 19: 231-238.
17.
Hodgson A, Vesprini D, Liu SK, et al. Correlation of mismatch repair protein deficiency, PD-L1 and CD8 expression in high-grade urothelial carcinoma of the bladder. J Clin Pathol 2020; 73: 519-522.
18.
Laguna MP. Re: hereditary-like urothelial carcinomas of the upper urinary tract benefit more from adjuvant cisplatin-based chemotherapy after radical nephroureterectomy than do sporadic tumours. J Urol 2015; 193: 72.
19.
Schulz GB, Todorova R, Braunschweig T, et al. PD-L1 expression in bladder cancer: Which scoring algorithm in what tissue? Urol Oncol 2021; 39: 734.e1-734.e10.
20.
Zhou TC, Sankin AI, Porcelli SA, et al. A review of the PD-1/PD-L1 checkpoint in bladder cancer: From mediator of immune escape to target for treatment. Urol Oncol 2017; 35: 14-20.
21.
Wang Y, Zhuang Q, Zhou S, et al. Costimulatory molecule B7-H1 on the immune escape of bladder cancer and its clinical significance. J Huazhong Univ Sci Technolog Med Sci 2009; 29: 77-79.
22.
Giedl J, Schneckenpointner R, Filbeck T, et al. Low frequency of HNPCC-associated microsatellite instability and aberrant MMR protein expression in early-onset bladder cancer. Am J Clin Pathol 2014; 142: 634-639.
23.
Vaish M, Mandhani A, Mittal RD, et al. Microsatellite instability as prognostic marker in bladder tumors: a clinical significance. BMC Urol 2005; 5: 2.
24.
Joost P, Therkildsen C, Dominguez-Valentin M, et al. Urinary tract Cancer in lynch syndrome; increased risk in carriers of MSH2 mutations. Urology 2015; 86: 1212-1217.
25.
Harper HL, McKenney JK, Heald B, et al. Upper tract urothelial carcinomas: frequency of association with mismatch repair protein loss and lynch syndrome. Mod Pathol 2017; 30: 146-156.
26.
Ju JY, Mills AM, Mahadevan MS, et al. Universal Lynch Syndrome Screening Should be Performed in All Upper Tract Urothelial Carcinomas. Am J Surg Pathol 2018; 42: 1549-1555.
27.
Ma J, Zhou Q, Xu W, et al. Urine PD-L1 is a tumor tissue candidate substitute and is associated with poor survival in muscle-invasive bladder cancer patients. Int Immunopharmacol 2023; 114: 109535.
28.
Chen X, Chen H, Lin R, et al. Correlation between PD-L1 expression of the tumour cells and lymphocytes infiltration in the invasive front of urothelial carcinoma. J Clin Pathol 2022; doi: 10.1136/jclinpath-2021-207795.
29.
Boorjian SA, Sheinin Y, Crispen PL, et al. T-cell coregulatory molecule expression in urothelial cell carcinoma: clinicopathologic correlations and association with survival. Clin Cancer Res 2008; 14: 4800-4808.
30.
Kumar U, Anthony ML, Sahai R, et al. Immunoexpression of PD-L1 and PD-1 and Its Clinicopathological Correlation in Urothelial Carcinomas. J Lab Physicians 2021; 14: 197-201.
31.
Le DT, Uram JN, Wang H, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med 2015; 372: 2509-2520.
32.
Kim ST, Klempner SJ, Park SH, et al. Correlating programmed death ligand 1 (PD-L1) expression, mismatch repair deficiency, and outcomes across tumor types: implications for immunotherapy. Oncotarget 2017; 8: 77415-77423.
33.
Zavalishina LE, Andreeva YY, Olyushina EM, et al. Immunohistochemical study of the MSI phenotype of urothelial bladder cancer. Arkh Patol 2020; 82: 5-14.
34.
Bellmunt J, Powles T, Vogelzang NJ. A review on the evolution of PD-1/PD-L1 immunotherapy for bladder cancer: The future is now. Cancer Treat Rev 2017; 54: 58-67.
35.
Liub Y, Wangc M, Cheng Q, et al. A novel heterozygous large deletion of MSH6 gene in a Chinese family with Lynch syndrome. Gene 2019; 704: 103-112.