Programmed death ligand 1 expression in early stage, resectable non-small cell lung cancer
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Manolo D’Arcangelo1, Armida D’Incecco2, Claudia Ligorio3, Stefania Damiani3, Maurizio Puccetti4, Sara Bravaccini5, Luigi Terracciano6, Chiara Bennati1, Gabriele Minuti1, Silvia Vecchiarelli1, Lorenza Landi1, Marina Milesi7, Alberto Meroni8, Sara Ravaioli5, Maria Maddalena Tumedei5, Matteo Incarbone8 and Federico Cappuzzo1
1AUSL della Romagna, Department of Oncology-Hematology, Ravenna, Italy
2University Hospital of Siena, Medical Oncology and Immunotherapy, Center for Immuno-Oncology, Siena, Italy
3University of Bologna, DIMES, Pathology, Bologna, Italy
4AUSL della Romagna, Department of Pathology, Ravenna, Italy
5Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCSS, Bioscences Laboratory, Meldola, Italy
6University Hospital Basel, Institute of Pathology, Basel, Switzerland
7Clinica San Carlo, Service of Pathology, Paderno Dugnano, Italy
8RCCS MultiMedica, Thoracic Surgery, Sesto S.G., Italy
Federico Cappuzzo, email: [email protected]
Keywords: PD-L1; NSCLC; prognosis; tumor grading
Received: April 25, 2018 Accepted: December 10, 2018 Published: January 15, 2019
Introduction: For several years non-small cell lung cancer (NSCLC) has been considered non-immunogenic. Recent advances in antitumor immunity brought to the discovery of checkpoints that modulate immune response against cancer. One of them is programmed death receptor 1 (PD-1) and its ligand (PD-L1). Although PD-L1 expression seems predictive of response to anti-PD-1/PD-L1 agents, its prognostic value is unclear. In this study we investigated the prognostic value of PD-L1 expression and its correlation with clinical-pathological characteristics in a cohort of surgically resected NSCLC.
Material and methods: PD-L1 expression was evaluated in 289 surgically resected NSCLC samples by immunohistochemistry. Our cohort included patients not exposed to adjuvant chemotherapy. PD-L1 status was defined as: 1) PD-L1 high (tumor proportion score, TPS≥50%), PD-L1 low (TPS 1-49%), PD-L1 negative (TPS<1%); 2) PD-L1 positive (TPS≥50%) and negative (TPS<50%); 3) as a continuous variable.
Results: Patients were mostly males (79%), former or current smokers (81%), with a median age of 67 years, non-squamous histology (67.5%) and high-grade tumors (55%). PD-L1 tumors were 18.7%. There was no significant association with sex, age, smoking status and histology. A strong correlation between high PD-L1 expression and tumor grade was detected. The difference in median OS in the different groups of patients was not statistically significant.
Conclusion: PD-L1 is not prognostic in surgically resected NSCLC. The association with tumor differentiation suggests that grading could represent an easy-to-assess tool for selecting subjects potentially sensitive to immunotherapy warranting further investigations.
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