“…While epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors have shown remarkable benefits for EGFR- and ALK- positive LUAD patients compared to conventional chemotherapy, the five-year survival rate remains low due to the emergence of primary and acquired resistance [ 7 ]. Immunotherapy, represented by anti-programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) antibody has created a new prospect in LUAD treatment [ 8 ]. The biomarkers such as PD-L1 expression and tumor mutation burden (TMB) can be used to predict survival, but their predictive value were far from satisfactory due to the high heterogeneity of LUAD [ 9 , 10 ].…”