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Background: Programmed cell-death ligand 1 (PD-L1) is a protein expressed at varying levels on the surface of cancer cells. Uncertainty exists regarding its relevance in breast cancer (BC). We aimed to perform a systematic review and meta-analysis evaluating the clinicopathological and prognostic role of PD-L1 in BC. Methods: A systematic review was performed in accordance to PRISMA and MOOSE guidelines. Observational studies that compared high versus low expression of PDL-1 on BC cells were identified. Log hazard ratios (lnHR) for diseasefree survival (DFS) and overall survival (OS) and their standard errors were calculated from Kaplan-Meier curves or cox-regression analyses and pooled using the inverse variance method. Dichotomous variables were pooled as odds ratios (OR) using the Mantel–Haenszel method. Results: Sixty-five studies of 19,870 patients were included; 14,390 with lowand 4,989 with high-PDL-1 expression. High PD-L1 was associated with grade 3 tumours [OR: 2.16, 95% confidence interval (CI): 1.64–2.83, P<0.01, heterogeneity (I) =82%], estrogen receptor negativity (OR: 2.29, 95% CI: 1.54–3.41, P<0.01, I=89 percent), progesterone receptor negativity (OR: 2.44, 95% CI: 1.69–3.51, P<0.01, I=83%), Ki-67 expression >14% (OR: 2.12, 95% CI: 1.23–3.65, P<0.01, I=89%) and achieving pathological complete response (pCR) following neoadjuvant chemotherapy (NAC) (OR: 3.31, 95% CI: 1.20–9.11, P<0.01, I=85%). Low PD-L1 was associated with human epidermal growth factor receptor-2 (OR: 3.98, 95% CI: 1.81–8.75, P<0.01, I=96 percent) and luminal (OR: 14.93, 95% CI: 6.46–34.51, P<0.01, I=99%) molecular subtypes. Those with low PD-L1 had favourable OS rates (hazard ratio: 1.30, 95% CI: 1.05–1.61, P<0.01, I=85%). Conclusions: BCs with high PD-L1 expression are associated with aggressive clinicopathological and immunohistochemical characteristics and are more likely to achieve pCR following NAC. However, they are associated with worse OS outcomes.

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AB003. SOH21AS040. Clinicopathological and prognostic significance of programmed death-ligand 1 expression in patients diagnosed with breast cancer: a systematic review and meta-analysis