PD-L1 expression as a predictor of postoperative recurrence and the association between the PD-L1 expression and EGFR mutations in NSCLC

Abstract

Although information on the PD-L1 expression and EGFR mutations in non-small cell lung cancer (NSCLC) is important for therapeutic strategies, the effect of these factors on postoperative recurrence and the association between each factor have remained unclear. We retrospectively assessed the PD-L1 expression and EGFR mutations in 280 NSCLC patients, and analyzed the associations by multivariate analyses. The hazard ratio (HR) of postoperative recurrence in cases with high (≥ 50%) PD-L1 expression regarding negative expression was 4.83 (95% confidence interval [CI] 1.51–15.5). The HR for the PD-L1 expression, considered a continuous variable, was 1.016 (95% CI 1.01–1.03). The HRs in cases with EGFR major and minor mutations were 0.42 (95% CI 0.14–1.25) and 0.63 (95% CI 0.18–2.15), respectively. The high PD-L1 (≥ 50%) expression was significantly associated with exon 21 L858R mutation (Ex21) of EGFR (odds ratio, 0.10; 95% CI 0.01–0.87). The risk of postoperative recurrence increased 1.016-fold for every 1% increase in the PD-L1 expression, and a marked increase in risk was observed for expression levels of ≥ 50%. Whereas EGFR mutations were not an independent risk factor. The high PD-L1 (≥ 50%) expression was negatively associated with Ex21. These findings may help identify NSCLC patients with an increased risk of postoperative recurrence.

The product of the PD-L1 expression and neutrophil-to-lymphocyte ratio as a predictor of postoperative recurrence in non-small-cell lung cancer

“…It is considered that the expression of PD-L1 in tumor cells is associated with a poor prognosis, as such lesions tend to show malignant tumor growth via immunosuppression. In fact, this theory has been supported by several studies [8,9], including our previous report [10]. However, since there are lung cancer patients with a high PD-L1 expression who have a good postoperative course in clinical practice, while other lung cancer patients with a low PD-L1 expression may show a poor postoperative course in clinical practice, the factors related to tumor immunity other than PD-L1 may also have a signi cant impact on the postoperative prognosis.…”

Current Immunotherapeutic Strategies Targeting the PD-1/PD-L1 Axis in Non-Small Cell Lung Cancer with Oncogenic Driver Mutations

“…These results indicate the types of resistance mechanisms to EGFR-TKIs that promote the immune escape of tumor cells through different molecular mechanisms ( Figure 1 ). Based on these findings, several studies showed that PD-L1 expression levels as measured by immunohistochemistry (IHC) are relatively higher in advanced NSCLC with EGFR mutation or ALK fusion compared with that of NSCLC with wild-type EGFR and ALK , though the results of some studies were inconsistent [ 79 , 80 , 81 ].…”

PD-L1 expression is not a predictive factor for recurrence in resected non-small cell lung cancer Sub-heading: PD-L1 is not a predictive factor for recurrence

“…The relationship between PD-L1 expression and EGFR mutations is controversial. In some reports, PD-L1 expression was signi cantly associated with wild-type EGFR whereas high PD-L1 expression (≥ 50%) was negatively associated with EGFR L858R mutation in exon 21 10,24 . Furthermore, several reports showed no association between PD-L1 expression and EGFR mutation 9,25,26 , whereas it was reported that PD-L1 expression was signi cantly associated with the presence of EGFR mutations 27 .…”

“…However, the prognostic relevance of PD-L1 expression in NSCLC is controversial. Although PD-L1 expression was revealed as a poor prognostic factor for NSCLC in several reports [6][7][8][9][10][11] , several studies demonstrated that PD-L1 expression is correlated with better prognosis 12,13 , while others have reported it as having no prognostic relevance 14,15 .…”