Abstract
Background
Recently, anti–programmed cell death 1 (PD-1) and anti–programmed cell death ligand
1 (PD-L1) immunotherapies have yielded promising outcomes for patients with advanced
non–small cell lung cancer (NSCLC) and led to great interest in applying these agents
to treat resectable early-stage NSCLC. The objective of our study was to evaluate
PD-L1 protein expression in resectable early-stage NSCLC specimens from a large Northern
European cohort, examine the relationship to clinical characteristics, and demonstrate
the prognostic role in resected NSCLC.
Materials and Methods
A large cohort of 875 NSCLC tumors consisted of 337 patients from Sweden and 538 patients
from Norway was studied. All the patients had undergone pulmonary resection, and most
patients had had early-stage NSCLC. PD-L1 protein expression was assessed by immunohistochemistry
using the Dako PD-L1 22C3 pharmDx kit. The tumor proportion score for PD-L1 protein
expression was compared with comprehensive demographic and clinicopathologic data.
Results
The overall prevalence of PD-L1 protein expression in the resectable NSCLC cohort
was 9.5% at a tumor proportion score cutoff of ≥ 50%. Stage I NSCLC had lower PD-L1
expression compared with that of the other stages (P = .0012). PD-L1 expression correlated with wild-type EGFR gene expression (P = .0156) and mutated KRAS gene expression (P = .0004). No significant association was found between PD-L1 expression and mortality
after multivariable adjustment for clinical characteristics, although the survival
curves showed PD-L1 expression significantly correlated with a poor prognosis in the
total NSCLC cohort and in the adenocarcinoma subgroup.
Conclusion
PD-L1 expression in the present large cohort of resectable NSCLC was relatively low
compared with data from clinical trials of advanced NSCLC. PD-L1 expression correlated
positively with tumor stage, wild-type EGFR, and KRAS mutation. PD-L1 expression was not found as an independent prognostic factor in the
present study. These findings could be important in the future when evaluating the
role of anti–PD-1/PD-L1 immunotherapy in the setting of neoadjuvant or adjuvant trials
for early-stage resectable NSCLC.
Keywords
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Article info
Publication history
Published online: October 14, 2020
Accepted:
September 21,
2020
Received in revised form:
September 10,
2020
Received:
April 8,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
