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. 2017 Aug;9(8):2579-2586.
doi: 10.21037/jtd.2017.08.61.

Unique distribution of programmed death ligand 1 (PD-L1) expression in East Asian non-small cell lung cancer

Yunjian Pan  1   2 , Difan Zheng  1   2 , Yuan Li  2   3 , Xu Cai  2   3 , Zongli Zheng  4   5 , Yan Jin  2   3 , Haichuan Hu  6 , Chao Cheng  1   2 , Lei Shen  1   3 , Jian Wang  1   3 , Hongbin Ji  7 , Yihua Sun  1   2 , Xiaoyan Zhou  2   3 , Haiquan Chen  1   2
Affiliations

Unique distribution of programmed death ligand 1 (PD-L1) expression in East Asian non-small cell lung cancer

Yunjian Pan et al. J Thorac Dis. 2017 Aug.

Abstract

Background: To determine the proportion and clinical features of programmed death ligand 1 (PD-L1) expression in East Asian non-small cell lung cancer (NSCLC).

Methods: PD-L1 expression was assessed by immunohistochemistry (IHC) and tumor proportion score (TPS) with the use of PD-L1 IHC 22C3 antibody (Dako North America) in 108 surgically resected lung squamous cell carcinomas (SCC) and 221 lung adenocarcinomas (LUADs), and was correlated with clinical variables, histologic subtypes, and common driver mutations.

Results: Positive PD-L1 expression was found in 37 lung SCC (37/108, 34.3%), including 15 cases with TPS ≥50% (15/108, 13.9%) and 22 cases with TPS <50% (22/108, 20.4%). In adenocarcinoma cohort, 9 cases were found PD-L1 expression positive (9/221, 4.1%), including 1 case with TPS ≥50% (1/221, 0.5%) and 8 cases with TPS <50% (8/221, 3.9%). Totally, high PD-L1 expression (TPS ≥50%) was significantly associated with male sex (P=0.026), current/ever smoking history (P=0.008) and SCC subtype (P<0.001). Positive PD-L1 expression (including TPS ≥50% and TPS <50%) in LUAD cohort was significantly associated with male sex (P=0.046), current/ever smoking history (P=0.002), mutation pan-negative status (P=0.038), solid-predominant subtype (P<0.001), large tumor size (P=0.027) and lymph node metastasis (P=0.019). No significant difference was found between PD-L1 high expression group (TPS ≥50%) and low/negative expression group in SCC cohort.

Conclusions: This study revealed the unique distribution of PD-L1 expression in East Asian NSCLCs, which is largely different from Western populations. Since the high response rate of pembrolizumab in the treatment of lung cancer patients with PD-L1 TPS ≥50%, this result indicates that prospective PD-L1 expression testing in specific East Asian patients could facilitate decision making for immunotherapy.

Keywords: Programmed death ligand 1 expression (PD-L1 expression); non-small cell lung cancer (NSCLC); survival.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparison of PD-L1 expression in different subgroups. PD-L1, programmed death ligand 1 expression; TPS, tumor proportion score; SCC, squamous cell carcinomas; LUAD, lung adenocarcinoma.
Figure 2
Figure 2
Representative images of positive PD-L1 expression in lung squamous cell carcinoma and adenocarcinoma. (A) Shows an image of squamous cell carcinoma with PD-L1 expression and amplified image is shown in (B). (C) Shows an image of adenocarcinoma with PD-L1 expression and amplified image is shown in (D). PD-L1, programmed death ligand 1 expression.
Figure 3
Figure 3
Kaplan-Meier survival curves for relapse-free survival and overall survival. (A) Relapse-free survival of 319 NSCLC patients; (B) overall survival of 319 NSCLC patients; (C) relapse-free survival of 98 SCC patients; (D) overall survival of 98 SCC patients. NSCLC, non-small cell lung cancer; SCC, squamous cell carcinomas.
See this image and copyright information in PMC

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