The Prognostic Impact of PD-L2 in Papillary Renal-Cell Carcinoma

Abstract

<b><i>Introduction:</i></b> Programmed death-1 ligand (PD-L1) has been often studied in different types of renal-cell carcinoma (RCC). For example, in clear-cell renal carcinoma it is well established that programmed death-1 receptor and PD-L1 are important prognostic markers. In contrast, the role of programmed death-2 ligand (PD-L2) as prognostic marker remains unclear. The aim of this study was to evaluate if PD-L2 expression could play a role as a prognostic marker for papillary RCC (pRCC). <b><i>Methods:</i></b> The patients’ sample collection was a joint collaboration of the PANZAR consortium. Patients’ medical history and tumor specimens were collected from <i>n</i> = 240 and <i>n</i> = 128 patients with type 1 and 2 pRCC, respectively. Expression of PD-L2 was determined by immunohistochemistry. In total, PD-L2 staining was evaluable in 185 of 240 type 1 and 99 of 128 type 2 pRCC cases. <b><i>Results:</i></b> PD-L2 staining was positive in 67 (36.2%) of type 1 and in 31 (31.3%) of type 2 pRCC specimens. The prevalence of PD-L2+ cells was significantly higher in high-grade type 1 tumors (<i>p</i> = 0.019) and in type 2 patients with metastasis (<i>p</i> = 0.002). Kaplan-Meier analysis disclosed significant differences in 5-year overall survival (OS) for patients with PD-L2− compared to PD-L2+ in pRCC type 1 of 88.4% compared to 73.6% (<i>p</i> = 0.039) and type 2 of 78.8% compared to 39.1% % (<i>p</i> &#x3c; 0.001). However, multivariate analysis did not identify the presence of PD-L2+ cells neither in type 1 nor type 2 pRCC as an independent predictor of poor OS. <b><i>Discussion/Conclusion:</i></b> PD-L2 expression did not qualify as an independent prognostic marker in pRCC. Future studies will have to determine whether anti-PD-L2-targeted treatment may play a role in pRCC and expression can potentially serve as a predictive marker for these therapeutic approaches.