PDF(Pubmed)
Abstract：
The management of advanced bladder carcinoma involves a multidisciplinary approach, but the prognosis remains poor for many patients. The immune system plays a crucial role in this disease, influencing both tumor development and response to treatment, and exploiting the immune system against the tumor can be a valuable strategy to destroy neoplastic cells. This is the biological principle underlying Bacillus Calmette-Guérin (BCG) use and, more recently, immune checkpoint inhibitors (ICIs), like PD-1 (programmed death-1)/PD-L1 (programmed death-ligand 1) inhibitors. In fact, one of the best studied immune checkpoints is represented by the PD-1/PD-L1 axis, which is a well-known immune escape system adopted by neoplastic bladder cells. PD-L1 expression has been associated with a higher pathologic stage and has shown prognostic value in bladder carcinoma. Interestingly, high-grade bladder cancers tend to express higher levels of PD-1 and PD-L1, suggesting a potential role of such an axis in mediating disease progression. Immunotherapy with PD-1 and PD-L1 inhibitors has therefore emerged as a valuable treatment option and has shown efficacy in advanced bladder cancer patients, with high PD-L1 expression levels associated with better treatment responses. Our review aims to provide a comprehensive overview of the role of PD-L1 in advanced bladder cancer, focusing on its implications for treatment decisions and the prediction of treatment response. Overall, our work aims to contribute to the understanding of PD-L1 as a predictive biomarker and highlight its role in shaping therapeutic approaches for advanced bladder cancer.
摘要：
晚期膀胱癌的治疗涉及多学科方法，但许多患者的预后仍然较差。免疫系统在这种疾病中起着至关重要的作用，影响肿瘤的发展和对治疗的反应，利用免疫系统对抗肿瘤可能是破坏肿瘤细胞的有价值的策略。这是卡介苗（BCG）使用的生物学原理，最近,免疫检查点抑制剂（ICIs），如PD-1（程序性死亡-1）/PD-L1（程序性死亡-配体1）抑制剂。事实上,研究最好的免疫检查点之一是由PD-1/PD-L1轴代表，这是肿瘤膀胱细胞采用的众所周知的免疫逃逸系统。PD-L1表达与较高的病理分期相关，并在膀胱癌中显示出预后价值。有趣的是,高级别膀胱癌倾向于表达更高水平的PD-1和PD-L1,提示此类轴在介导疾病进展中的潜在作用.因此，PD-1和PD-L1抑制剂的免疫治疗已成为一种有价值的治疗选择，并已在晚期膀胱癌患者中显示出疗效。PD-L1高表达水平与更好的治疗反应相关。我们的综述旨在全面概述PD-L1在晚期膀胱癌中的作用。重点关注其对治疗决策和治疗反应预测的影响。总的来说,我们的工作旨在有助于理解PD-L1作为一种预测性生物标志物,并强调其在形成晚期膀胱癌治疗方法中的作用.
