Abstract:

Objective To investigate the expression correlation of PD-L1 and Her-2 in invasive urothelial carcinoma （IUC） and their impact on patient prognosis， providing a basis for precise stratified treatment and prognostic evaluation. Methods A total of 60 IUC patients were included from May 2021 to May 2024. Immunohistochemistry was used to detect the expression levels of Her-2 and PD-L1 in tumor tissues. The correlation between their expressions and clinicopathological parameters （tumor differentiation grade， TNM stage， lymph node metastasis， etc.） was analyzed. Kaplan-Meier method and Log-rank test were used to compare progression-free survival （PFS） and overall survival （OS） among patients with different expression statuses. Cox proportional hazard regression model was applied to identify independent prognostic risk factors. Additionally， the diagnostic efficacy of combined Her-2 and PD-L1 detection for poor prognosis was evaluated. Results The positive rate of Her-2 was 38.33% （23/60）， and the high expression rate of PD-L1 was 41.67% （25/60）. Both expressions were positively correlated with low tumor differentiation （r = 0.360/0.280， P < 0.05） and clinical stage Ⅲ—Ⅳ （r = 0.395/0.325， P < 0.05）. Multivariate analysis revealed that Her-2 positivity （HR = 1.878， P = 0.042） and high PD-L1 expression （HR = 1.822， P = 0.039） were independent risk factors for poor prognosis. The AUC of combined Her-2 and PD-L1 detection was 0.830 （P < 0.001）， with a sensitivity of 82.14% and specificity of 81.25%， which was significantly better than single indicators （P < 0.05）. Conclusions Her-2 positivity and high PD-L1 expression are independent risk factors for tumor progression and poor prognosis in IUC patients. Combined detection of the two can improve the efficacy of prognostic evaluation and provide a new biomarker combination for precise stratified treatment of IUC.

Key words: invasive urothelial carcinoma, PD-L1, Her-2, prognosis, biomarker