Purpose
We investigated the correlation between immunohistochemical PD-L1
expression and tumor-associated immune cells (TAICs) density in
non–small cell lung carcinoma (NSCLC) and correlated them with
clinicopathologic variables.
Experimental Design
Tumor tissue specimens from 254 stage I–III NSCLCs
[146 adenocarcinomas; 108 squamous cell carcinomas (SCCs)]
were examined. PD-L1 expression in malignant cells and macrophages and the
density of TAICs expressing CD3, CD4, CD8, CD57, granzyme B, CD45RO, PD-1,
FOXP3, and CD68 were evaluated using immunohistochemistry and image
analysis.
Results
Malignant cells PD-L1 H-score > 5 was detected in
23% of adenocarcinomas and 31% of SCCs, and no significant
differences were detected comparing both histologies; the median
H-score in macrophages was significantly higher in SCC
than in adenocarcinoma (P < 0.001). In adenocarcinoma,
high malignant cells PD-L1 expression and high TAIC density correlated with
solid histology, smoking history, and airflow limitation. Multivariate
analysis demonstrated that high CD57-positive cell density correlated with
better recurrence-free survival (RFS; P = 0.0236;
HR, 0.457) and overall survival (OS; P = 0.0261;
HR, 0.481) rates for SCC. High CD68-positive cell density in intratumoral
compartment correlated with better RFS (P = 0.0436;
HR, 0.553) for adenocarcinoma. The combination of low CD4/CD8/C68-positive
cell density and PD-L1 H-score >5 in malignant cells
identified small subset of adenocarcinomas with worse outcomes (RFS:
P = 0.036; HR, 4.299; OS: P
= 0.00034; HR, 5.632).
Conclusions
We detected different PD-L1 expression and TAIC density patterns in
NSCLC. Distinct groups of tumor microenvironment correlated with NSCLC
clinicopathologic features, including outcome.