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Cekani E, Martorell C, Martucci F, Patella M, Cafarotti S, Valenti A, Freguia S, Molinari F, Froesch P, Frattini M, Stathis A, Wannesson L. Prognostic implication of PD-L1 in early-stage non-small cell lung cancer: a retrospective single-centre study. Swiss Med Wkly 2023; 153:40110. [PMID: 37769653 DOI: 10.57187/smw.2023.40110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The prognostic role of programmed death-ligand 1 (PD-L1) expression in patients with localised and locally advanced non-small cell lung cancer has not been fully elucidated. This information could help to better interpret recent and upcoming results of phase III adjuvant or neoadjuvant anti-PD-1/PD-L1 immunotherapy studies. METHODS In a cohort of 146 patients with early or locally advanced non-small cell lung cancer treated with curative intent (by surgery or radiotherapy), we investigated the prognostic value of PD-L1 expression and its correlation with other biological and clinical features. PD-L1 expression was stratified by quartiles. Primary endpoints were overall and disease-free survival. We also analysed the prognostic impact of the presence of actionable mutations, implemented treatment modality and completion of the treatment plan. Neither type of patient received neoadjuvant or adjuvant immunotherapy or target therapy. RESULTS Of the 146 selected patients, 32 (21.9%) presented disease progression and 15 died (10.3%) at a median follow-up of 20 months. In a univariable analysis, PD-L1 expression ≥25% was associated with significantly lower disease-free survival (hazard ratio [HR]) 1.9, 95% confidence interval [CI] 1.0-3.9, p = 0.049). PD-L1 expression ≥50% did not lead to disease-free survival or overall survival benefits (HR 1.2 and 1.1, respectively; 95% CI 0.6-2.6 and 0.3-3.4, respectively; pnot significant). In a multivariate analysis, a stage >I (HR 2.7, 95% CI 1.2-6, p = 0.012) and having an inoperable tumour (HR 3.2, 95% CI 1.4-7.4, p = 0.005) were associated with lower disease-free survival. CONCLUSION The population of patients with early-stage non-small cell lung cancer and PD-L1 expression ≥25% who were treated with curative intent during the pre-immunotherapy era exhibited a worse prognosis. This finding provides justification for the utilisation of adjuvant immunotherapy in this subgroup of patients, based on the current evidence derived from disease-free survival outcomes. However, for patients with PD-L1 expression <25%, opting to wait for the availability of the overall survival results may be a prudent choice.
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Affiliation(s)
- Elona Cekani
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Carolina Martorell
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Francesco Martucci
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Miriam Patella
- Thoracic Surgery Department, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Stefano Cafarotti
- Thoracic Surgery Department, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Antonio Valenti
- Pneumology Department, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | | | | | - Patrizia Froesch
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | | | - Anastasios Stathis
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Luciano Wannesson
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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Gallina FT, Bertolaccini L, Forcella D, Mohamed S, Ceddia S, Melis E, Fusco F, Bardoni C, Marinelli D, Buglioni S, Visca P, Cappuzzo F, Spaggiari L, Facciolo F. Analysis of Molecular Biomarkers in Resected Early-Stage Non-Small Cells Lung Cancer: A Narrative Review. Cancers (Basel) 2022; 14:cancers14081949. [PMID: 35454856 PMCID: PMC9024905 DOI: 10.3390/cancers14081949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary In the last few years, the treatment of advanced NSCLC has radically changed after the development of new drugs against specific molecular targets. Moreover, multiple tumour biopsies have become mandatory in order to better select the appropriate targeted therapy. Molecular analysis using NGS in the early stage of NSCLC is still relatively widespread. The recent clinical trials that use targeted therapies in neoadjuvant and adjuvant settings also require molecular characterisation for early-stage patients. Due to the widespread use of molecular analysis in patients with early-stage NSCLC, the prognostic role of molecular biomarkers needs to be fully understood. This paper aimed to review the most recent studies associating the molecular expressions of early-stage NSCLC with survival. Abstract Next-generation sequencing has become a cornerstone in clinical oncology practice and is recommended for the appropriate use of tailored therapies in NSCLC. While NGS has already been standardised in advanced-stage NSCLC, its use is still uncommon in the early stages. The recent approval of Osimertinib for resected EGFR-mutated NSCLC in an adjuvant setting has launched the hypothesis that other targeted therapies used in metastatic patients can also lead to improved early-stage outcomes of NSCLC. The impact of molecular biomarkers on the prognosis of patients undergoing radical surgery for NSCLC is still unclear. Notably, the heterogeneous populations included in the studies that analysed surgical patients could be the main reason for these results. In this review, we report the most important studies that analysed the impact of principal molecular biomarkers on the survival outcomes of patients who underwent radical surgery for NSCLC.
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Affiliation(s)
- Filippo Tommaso Gallina
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (D.F.); (E.M.); (F.F.)
- Correspondence: ; Tel.: +39-06-5266-5832; Fax: +39-06-5266-6993
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20100 Milan, Italy; (L.B.); (S.M.); (C.B.); (L.S.)
| | - Daniele Forcella
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (D.F.); (E.M.); (F.F.)
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20100 Milan, Italy; (L.B.); (S.M.); (C.B.); (L.S.)
| | - Serena Ceddia
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.C.); (F.F.); (F.C.)
| | - Enrico Melis
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (D.F.); (E.M.); (F.F.)
| | - Francesca Fusco
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.C.); (F.F.); (F.C.)
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20100 Milan, Italy; (L.B.); (S.M.); (C.B.); (L.S.)
| | - Daniele Marinelli
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy;
| | - Simonetta Buglioni
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.B.); (P.V.)
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.B.); (P.V.)
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.C.); (F.F.); (F.C.)
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20100 Milan, Italy; (L.B.); (S.M.); (C.B.); (L.S.)
| | - Francesco Facciolo
- Thoracic Surgery Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (D.F.); (E.M.); (F.F.)
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Neoadjuvant and Adjuvant Immunotherapy in Non-Small Cell Lung Cancer-Clinical Trials Experience. Cancers (Basel) 2021; 13:cancers13205048. [PMID: 34680195 PMCID: PMC8534159 DOI: 10.3390/cancers13205048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary Surgical resection remains the gold standard of early-stage non-small cell lung cancer (NSCLC) treatment. However, only a minority of resected patients remain recurrence-free at 5 years. Systemic treatment with cisplatin-based chemotherapy after surgical resection has been shown to improve survival in this setting. In the last few years, immunotherapy has established its position in treatment of metastatic lung cancer patients. Can the phenomenal results of this treatment be directly transferred to early NSCLC patients? Clinical trials with immunotherapy in this indication are ongoing, some with already promising results. In order to immediately prove the efficacy of immunotherapy in preoperative use, the surrogates of overall and progression free survival have to be validated. In this article, we review the data in support of immunotherapy in adjuvant and neoadjuvant treatment of early NSCLC patients together with new definitions of primary end points of these studies. Abstract Across all tumor types, we observe that the role of immunotherapy has increased rapidly. Due to a number of potential advantages, it is considered in neoadjuvant treatment of localized tumors. In neoadjuvant settings, immunotherapy addresses micrometastatic diseases at the moment of their formation. However, some issues concerning neoadjuvant and adjuvant immunotherapy still has to be covered. The choice of drug and use of monotherapy or combination regimens remains unclear. The timing of surgery and preoperative evaluation of neoadjuvant immunotherapy efficacy is challenging. Although there is currently limited confirmed clinical data to support the use of immune checkpoint blockade in the neoadjuvant and adjuvant settings, there are many studies exploring this strategy in NSCLC patients.
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Bravaccini S, Bronte G, Ulivi P. TMB in NSCLC: A Broken Dream? Int J Mol Sci 2021; 22:ijms22126536. [PMID: 34207126 PMCID: PMC8234326 DOI: 10.3390/ijms22126536] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/15/2021] [Indexed: 12/26/2022] Open
Abstract
Although immune checkpoint inhibitors have changed the treatment paradigm of a variety of cancers, including non-small-cell lung cancer, not all patients respond to immunotherapy in the same way. Predictive biomarkers for patient selection are thus needed. Tumor mutation burden (TMB), defined as the total number of somatic/acquired mutations per coding area of a tumor genome (Mut/Mb), has emerged as a potential predictive biomarker of response to immune checkpoint inhibitors. We found that the limited use of TMB in clinical practice is due to the difficulty in its detection and compounded by several different biological, methodological and economic issues. The incorporation of both TMB and PD-L1 expression or other biomarkers into multivariable predictive models could result in greater predictive power.
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Serum-derived exosomal PD-L1 expression to predict anti-PD-1 response and in patients with non-small cell lung cancer. Sci Rep 2021; 11:7830. [PMID: 33837261 PMCID: PMC8035184 DOI: 10.1038/s41598-021-87575-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022] Open
Abstract
PD-L1 expression is the most useful predictive biomarker for immunotherapy efficacy on non-small cell lung cancer (NSCLC), and CD8+ tumor-infiltrating lymphocytes (CD8+ TILs) play an essential role in the clinical activity of immunotherapy. PD-L1 is found on the exosome’s surface, and PD-L1 expressing exosomes can inhibit antitumor immune responses. This study aimed to analyze tumor PD-L1 expression, serum exosomal PD-L1, and CD8+ TILs to investigate anti-PD-1 response and clinicopathological outcomes in NSCLC. One hundred twenty patients with stage I–III NSCLC were enrolled, and serum samples collected during the initial surgery were pooled. The Human CD274/PD-L1 ELISA kit was used to quantify the exosomal PD-L1. Exosomal PD-L1 levels were significantly correlated with tumor PD-L1 levels (p < 0.001) and the number of CD8+ TILs (p = 0.001). Patients with exosomal PD-L1 ≥ 166 pg/mL tended to have a worse RFS than those with < 166 pg/mL in all stage (p = 0.163) and stage I patients (p = 0.116). Seventeen patients exhibited postoperative recurrences and received anti-PD-1 treatment. The disease control rate of patients with exosomal PD-L1 ≥ 166 pg/mL was 100%. The measurement of serum exosomal PD-L1 as a quantitative factor with tumor PD-L1 status may help predict anti-PD-1 response and clinical outcomes in patients with NSCLC.
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Vrankar M, Kern I, Stanic K. Prognostic value of PD-L1 expression in patients with unresectable stage III non-small cell lung cancer treated with chemoradiotherapy. Radiat Oncol 2020; 15:247. [PMID: 33121520 PMCID: PMC7594267 DOI: 10.1186/s13014-020-01696-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Expression of PD-L1 is the most investigated predictor of benefit from immune checkpoint blockade in advanced NSCLC but little is known about the association of PD-L1 expression and clinicopathological parameters of patients with unresectable stage III NSCLC. Methods National registry data was searched for medical records of consecutive inoperable stage III NSCLC patients treated with ChT and RT from January 2012 to December 2017. Totally 249 patients were identified that met inclusion criteria and of those 117 patients had sufficient tissue for PD-L1 immunohistochemical staining. Results Eighty patients (68.4%) expressed PD-L1 of ≥ 1% and 29.9% of more than 50%. Median PFS was 15.9 months in PD-L1 negative patients and 16.1 months in patients with PD-L1 expression ≥ 1% (p = 0.696). Median OS in PD-L1 negative patients was 29.9 months compared to 28.5 months in patients with PD-L1 expression ≥ % (p = 0.888). There was no difference in median OS in patients with high PD-L1 expression (≥ 50%) with 29.8 months compared to 29.9 months in those with low (1–49%) or no PD-L1 expression (p = 0.694). We found that patients who received a total dose of 60 Gy or more had significantly better median OS (32 months vs. 17.5 months, p < 0.001) as well as patients with PS 0 (33.2 vs. 20.3 months, p = 0.005). Conclusions In our patients PD-L1 expression had no prognostic value regarding PFS and OS. Patients with good performance status and those who received a total radiation dose of more than 60 Gy had significantly better mOS.
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Affiliation(s)
- Martina Vrankar
- Department of Radiotherapy, Institute of Oncology Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Izidor Kern
- Department of Pathology, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik 36, 4202, Golnik, Slovenia
| | - Karmen Stanic
- Department of Radiotherapy, Institute of Oncology Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
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Boscolo A, Fortarezza F, Lunardi F, Comacchio G, Urso L, Frega S, Menis J, Bonanno L, Guarneri V, Rea F, Conte P, Calabrese F, Pasello G. Combined Immunoscore for Prognostic Stratification of Early Stage Non-Small-Cell Lung Cancer. Front Oncol 2020; 10:564915. [PMID: 33072595 PMCID: PMC7544833 DOI: 10.3389/fonc.2020.564915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background To date, no combined immunoscore has been evaluated for prognostic stratification of early stage non-small-cell lung cancer (NSCLC). The main goal of this study was to investigate the prognostic impact of programmed death ligand 1 (PD-L1) expression and different immune cell components (CD4+, CD8+ T-lymphocytes, and CD68+ macrophages) in early stage NSCLC patients, distinguishing peritumoral (PT) and intratumoral (IT) localizations. The secondary aim was to identify a combined immunoscore to optimize the prognostic stratification of NSCLC patients. Methods This retrospective study included surgical specimens from consecutive chemo-naive stage II-III radically resected NSCLC patients. Immunohistochemistry was carried out to evaluate PD-L1 expression and to quantify IT and PT CD4+, CD8+ T-lymphocytes, and CD68+ macrophages. The impact of a single marker and of a combination of multiple markers on overall survival (OS) was investigated. Results Seventy-nine patients were included in the study. PD-L1 expression was associated with worse prognosis (3 years OS: 58% in high- compared with 67% in low-expressing tumors), even though without statistical significance. When integrating PT CD8+, CD4+, and CD68 into a combined PT immunoscore, a significant prognostic stratification of patients was obtained and confirmed at multivariate analysis (3 years OS: 86% in patients with low PT immunoscore vs. 59% in patients with high PT immunoscore, p = 0.018). The integration of derived neutrophil/lymphocyte ratio (dNLR) with combined PT immunoscore improved prognostic stratification, with longer OS in patients with low PT immunoscore and low dNLR (p = 0.002). Conclusion The combined PT immunoscore (CD8+, CD4+, and CD68) integrated with dNLR may be a promising marker for the development of an integrated Tumor, Node, Metastasis (TNM) immunoscore.
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Affiliation(s)
- Alice Boscolo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Francesco Fortarezza
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesca Lunardi
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Loredana Urso
- Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Stefano Frega
- Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Laura Bonanno
- Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Pasello
- Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
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Varela G, Novoa NM. EGFR and non-small cell lung cancer: implications for surgical practice. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1115. [PMID: 33145334 PMCID: PMC7575960 DOI: 10.21037/atm.2020.04.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Gonzalo Varela
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Nuria M. Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
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Jazieh AR, Bounedjar A, Bamefleh H, Alfayea T, Almaghraby HQ, Belarabi A, Ouahioune W, Derbouz Z, Alkaiyat M, Alkattan K, Damlaj M, Khalbuss WE. Expression of Immune Response Markers in Arab Patients With Lung Cancer. JCO Glob Oncol 2020; 6:1218-1224. [PMID: 32749860 PMCID: PMC7456317 DOI: 10.1200/go.20.00107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Programmed death-ligand 1 (PD-L1) is a marker for checkpoint inhibitor use in the management of solid tumors, especially in non-small-cell lung cancer (NSCLC). Our study was aimed at determining the patterns of PD-L1 expression and cluster of differentiation 8 (CD8) immunostains in patients with NSCLC in the Arab population. METHODS Archival tumor tissue from patients with a confirmed diagnosis of NSCLC were obtained and stained for PD-L1 with antibody 22C3, using immunohistochemistry staining and giving the tumor proportion score (TPS) as a percentage from 0%-100% of stained tumor cells. Tumors were categorized into negative expressers (TPS < 1%), low positive (TPS, 1%-49%), and high positive (TPS, 50%-100%). Correlation of expression with clinical and pathologic features, including CD8-positive (CD8+) lymphocyte density, was also analyzed. RESULTS Two hundred patients with NSCLC were included in the study from 6 centers in Saudi Arabia and Algeria. Median age was 65 years (28-93 years), and the majority were men (75%) with stage 4 NSCLC (64%). The TPS was high in 37 patients (18%), low in 60 patients (30%), and negative in 103 patients (52%). In a univariate analysis, the following were significant predictors of any PD-L1 expression (> 1%): male sex, being Saudi national patients, high expression of CD8+, and presence of tumor-infiltrating lymphocytes. In the multivariate analysis, only high expression of CD8+ cells (≥ 2+) was significant, with an odds ratio of 4.4 (95% CI, 1.5 to 12.9; P = .003). CONCLUSION PD-L1 expression in our population is similar to the published literature and correlated with the density of CD8+ cells. Validation of the predictive value of this marker in our population and identifying easier and reliable methods to test for it are warranted.
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Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Adda Bounedjar
- Universite Blida1 Laboratoire de Cancerologie, Faculte De Medicine, Blida, Algeria
| | - Hanaa Bamefleh
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Turki Alfayea
- Oncology Department, Princess Nourah Cancer Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Hatim Q. Almaghraby
- Department of Pathology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Ayed Belarabi
- Universite Blida1 Laboratoire de Cancerologie, Faculte De Medicine, Blida, Algeria
| | - Wahiba Ouahioune
- Universite Blida1 Laboratoire de Cancerologie, Faculte De Medicine, Blida, Algeria
| | - Zoubir Derbouz
- Universite Blida1 Laboratoire de Cancerologie, Faculte De Medicine, Blida, Algeria
| | - Mohammad Alkaiyat
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Khaled Alkattan
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Moussab Damlaj
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Walid E. Khalbuss
- Department of Oncology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
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Sumitomo R, Hirai T, Fujita M, Murakami H, Otake Y, Huang CL. PD-L1 expression on tumor-infiltrating immune cells is highly associated with M2 TAM and aggressive malignant potential in patients with resected non-small cell lung cancer. Lung Cancer 2019; 136:136-144. [PMID: 31499335 DOI: 10.1016/j.lungcan.2019.08.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES PD-L1 expression on tumor cells (TCs) and tumor-infiltrating immune cells (ICs) plays important roles in regulating the antitumor T cell response. However, the mechanistic and clinical significance of the effect of PD-L1 on TCs versus ICs remains unclear. On the other hand, tumor-associated macrophages (TAMs), M2 macrophages in particular, can promote tumor progression. METHODS We evaluated PD-L1 expression on TCs and ICs using Ventana SP263 assay and the stromal M2 TAM distribution using CD163 staining in 160 consecutive patients with resected non-small cell lung cancer (NSCLC). RESULTS PD-L1 expression on TCs and ICs was significantly higher in stromal M2 TAM-high group than in stromal M2 TAM-low group (p < 0.001 and p < 0.001, respectively). Regarding the clinical significance of PD-L1, PD-L1 expression on TCs was significantly associated with histology (p = 0.001), tumor differentiation (p < 0.001) and nodal status (p = 0.029). Furthermore, PD-L1 expression on ICs was significantly associated with histology (p < 0.001), tumor differentiation (p < 0.001), tumor status (p = 0.024), nodal status (p = 0.016), and pathologic stage (p = 0.004). The disease-free survival rate was significantly lower in patients with PD-L1-positive TC than in those with PD-L1-negative TC (p = 0.023), as well as in patients with PD-L1-positive IC than in those with PD-L1-negative IC (p < 0.001). Furthermore, the overall survival rate was significantly lower in patients with PD-L1-positive IC than in those with PD-L1-negative IC (p = 0.023). CONCLUSIONS During tumor progression in NSCLC, the presence of M2 TAMs might affect PD-L1 expression both on TCs and ICs. In patients with NSCLC, PD-L1 expression both on TCs and ICs was associated with malignant behaviors, which was more in case of ICs.
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Affiliation(s)
- Ryota Sumitomo
- Department of Thoracic Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tatsuya Hirai
- Department of Thoracic Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Masaaki Fujita
- Department of Clinical Immunology and Rheumatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Hiroaki Murakami
- Department of Thoracic Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Yosuke Otake
- Department of Thoracic Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Cheng-Long Huang
- Department of Thoracic Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
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