PD-L1 expression as poor prognostic factor in patients with non-squamous non-small cell lung cancer
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Cuiling Zhou1,*, Jianjun Tang2,*, Huanhuan Sun1,*, Xiaobin Zheng3, Zhanyu Li4, Tiantian Sun5, Jie Li6, Shuncong Wang1, Xiuling Zhou1, Hongliu Sun7, Zhibin Cheng1, Hongyu Zhang1 and Haiqing Ma1
1Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
2Department of Gastroenterology, Cancer Hospital of Jiangxi Province, Nanchang, Jiangxi 330029, China
3Department of Respiration, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
4Department of Pathology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
5Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
6Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
7Department of Pathology, University of Michigan, Ann Arbor, MI 48201, USA
*These authors have contributed equally to this work
Haiqing Ma, email: email@example.com
Hongyu Zhang, email: firstname.lastname@example.org
Keywords: NSCLC, PD-L1, survival, prognostic factor, histologic type
Received: August 29, 2016 Accepted: March 22, 2017 Published: April 11, 2017
Objectives: The role of programmed cell death ligand 1 (PD-L1) in non-small cell lung cancer (NSCLC), especially according to histologic type, remains controversial. The purpose of this study was to assess PD-L1 expression and its association with overall survival (OS) and clinicopathologic characteristics in NSCLC.
Materials and methods: Formalin-fixed paraffin-embedded specimens were obtained from 108 patients with surgically resected primary NSCLC. PD-L1 expression was assessed via immunohistochemistry using a histochemistry score system. The relationship between OS or clinicopathologic characteristics and PD-L1 expression was evaluated via the Kaplan-Meier method and Cox proportional hazards model, respectively.
Results: Of 108 NSCLC specimens, 44 had high PD-L1 expression, which was highly associated with histologic type (p = 0.003). Patients without PD-L1 expression had remarkably longer OS than those with PD-L1 expression (median OS: 96 months vs. 33 months, p < 0.001). In the subgroup analysis of non-squamous cell carcinoma, OS was more favorable in those without PD-L1 expression than in those with PD-L1 expression (median OS: 113 months vs. 37 months, p < 0.001). Multivariate analysis revealed that PD-L1 expression (95% confidence interval 1.459-4.520, p < 0.001), male sex and higher tumor-node-metastasis stage were significantly correlated with shorter OS.
Conclusions: This study demonstrated that PD-L1 expression is an independent prognostic factor for poor survival in NSCLC patients, especially those with non-squamous NSCLC.
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