Programmed Death Ligand-1 (Pd-L1) Expression in Neuroblastoma: A Single Pediatric Oncology Center Experience Publisher



Alqanbar MF ; Al Safi RAR ; Aljumaily U ; Jabbar S
Source: Innovative Journal of Pediatrics Published:2025

Abstract

Background: Neuroblastoma (NB) is the most common extracranial solid malignancy in children. Previous studies have highlighted the immunological component of the tumor microenvironment. While programmed death ligand 1 (PD-L1) pathway blockade has shown therapeutic promise in adult malignancies, little is known about the immunological factors associated with PD-L1 inhibition in pediatric malignancies, such as NB. Objectives: The present study aims to evaluate the prevalence of PD-L1 expression among NB patients in Karbala province and to analyze its correlation with clinicopathological parameters. Methods: A cross-sectional study was conducted on 28 patients diagnosed with NB. Data were collected from the oncology center in Karbala province for cases diagnosed between January 2018 and January 2023. The PD-L1 immunostaining was performed on 18 cases that met the inclusion criteria. Clinical and pathological data, including age, sex, histological subtype, histological favorability, and risk stratification, were analyzed. Results: Among the 18 patients, 10 were male (55.6%) and 8 were female (44.4%). The median age at diagnosis was 24 months. The PD-L1 expression was positive in 5 patients (27.8%) and negative in 13 patients (72.2%). A significant positive correlation was observed between PD-L1 expression and the histological subtype of NB (P = 0.02). The PD-L1 expression also showed a significant correlation with histological favorability (P = 0.009) and risk stratification (P = 0.03). Notably, 57.1% of patients in the high-risk group exhibited positive PD-L1 immunostaining, while all patients in the low-risk group (100%) were negative. Conclusions: The PD-L1 expression may serve as an independent prognostic factor in NB, being more frequently expressed in undifferentiated and poorly differentiated NB, particularly in cases with unfavorable histology and high-risk stratification. Copyright © 2025, Alqanbar et al.