PD-L1 est un marqueur dynamique comme l'ont montré Inman et al dans leur étude évaluant le rôle de PD-L1 dans une cohorte de TVNIM traités par BCG et de cystectomie pour TVIM (54). L'expression de PD-L1 varie avec le temps et selon les traitements, En effet ,
PD-L1 était fortement exprimé au sein des granulomes des patients présentant une récidive après BCG (> 90% des cellules PD-L1+) Ceci pourrait contribuer à la diminution de l'efficacité du BCG, expliquée par une accumulation de PD ,
63) ont démontré le lien entre l'expression de PD-L1 et l'agressivité de la tumeur en terme de stade et de grade ,
13 patients PD-L1 TC+ (seuil 1%) présentaient du CIS sur la lame initiale (37,1 %) contre 2 patients (5,7%) classés initialement pTa et 20 patients pT1 (57,1%) Nous avons mis en évidence une différence d'expression de PD-L1 statistiquement significative entre ces trois groupes ,
expression de PD-L1 43% de patients récidivant après les 6 instillations de BCG, 72% n'auront pas de tumeur sur une nouvelle évaluation à 6 mois ,
parmi nos 38 patients mauvais répondeurs, 36 récidivent de façon précoce (6 mois) sous la forme d'une tumeur de haut grade et pouvant donc être définis comme réfractaires au BCG selon la définition de l'IBCG ou récidive précoce selon les recommandations du CCAFU, 2016. ,
38 patients présentant de la tumeur sur le second look, la majorité étaient pT1 sur leur histologie initiale (n=25, soit 65,8%) comme l'avaient montré Divrik et al ,
nous n'avons pas mis en évidence de lien entre l'âge > 70 ans et la récidive tumorale, ce résultat étant concordant avec les résultats d'Oddens et al, p.64 ,
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