Background: Immune checkpoint molecules are important regulators of physiologic inflammatory responses, and are highly effective in behavior of many cancers. They are involved in production of anti-tumor immune response. This study aims to evaluate the expression and role of both PDL-1 and A2aR antibodies in bladder urothelial cancer.
Material & Methods: This was a retrospective study on 45 bladder urothelial cancers obtained from archives of Pathology Department, Faculty of Medicine, Benha University and from International Medical Center Hospital (IMC) during the period from January 2015 to December 2019. Immunohistochemical expression of A2aR was evaluated and compared with those of PDL-1. A2aR expression was also correlated with tumor infiltrating CD8+T cells. Relations to demographic data of the patients were evaluated.
Results: PDL-1 expression was detected in 24.4% of tumor cells ± immune cells. PDL-1 was significantly related to advanced PT stage (P˂0.01), Detruser muscle invasion (P˂0.05) and non-papillary tumor histology (P˂0.05)High expression of A2aR was detected in 40% of tumor specimens in tumor cells± immune cells. Higher A2aR expression was statistically significant related to higher tumor grade (P˂0.05), advanced PT stage (P˂0.01), Detruser muscle invasion (P˂0.01) and non-papillary tumor histology (P˂0.01) . The expression of A2aR was statistically significant related to PDL-1 expression (P˂0.01). Higher A2aR expression was statistically related to lower the density of tumor infiltrating CD8+T lymphocytes (P˂0.01). Using Roc curve, A2aR was more accurate than PDL-1 as AUC (0.648 and 0.565 respectively). Specificity of A2aR is higher than PDL-1 (51.9 and 29.6 respectively)
Conclusion: Both PDL-1 and A2aR markers could be useful in monitoring urothelial bladder cancer immunotherapy. A2aR is higher to and more specific than PDL-1 in predicting tumor lymphocytic infiltrate. A2aR antagonists could have a positive role in cases which are resistant to anti-PDL-1 immunotherapy.
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