Original Article
Translational Oncology
Prognostic Significance of PD-L1 in Patients with Non–Small Cell Lung Cancer: A Large Cohort Study of Surgically Resected Cases

Presented in part at the 50th Annual Meeting of the American Society of Clinical Oncology in Chicago, Illinois, May 30–June 3, 2014, and published as Sun J-M, et al. PD-L1 expression and survival in patients with non-small cell lung cancer in Korea [abstract]. J Clin Oncol. 2014;32(suppl 5):8066.
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Abstract

Introduction

The aim of our analysis was to evaluate the prognostic effect of programmed cell death ligand-1 (PD-L1) expression in patients with non–small cell lung cancer (NSCLC).

Methods

PD-L1 expression among 1070 surgically resected NSCLC specimens was evaluated by immunohistochemical analysis. Data were analyzed using Cox proportional hazard models adjusting for age, sex, smoking status, histologic type, stage, and performance status.

Results

Sixty-eight patients (6%) were strongly PD-L1 positive and 410 (38%) were weakly PD-L1 positive. A significantly higher prevalence of PD-L1 positivity was observed among patients with squamous cell carcinoma and among stage IIIB and IV patients. PD-L1 expression may be associated with poorer overall survival, with an adjusted hazard ratio of 1.56 (95% confidence interval [CI]: 1.08–2.26, p = 0.02) for strong PD-L1 positivity, 1.18 (95% CI: 0.96–1.46; p = 0.12) for weak PD-L1 positivity, and 1.23 (95% CI: 1.00–1.51; p = 0.05) for the combined strongly and weakly positive groups compared with PD-L1 negativity. Negative prognostic effect of PD-L1 expression was not statistically significant after adjustment for postoperative chemotherapy or radiotherapy. Similar results were observed for progression-free survival. Among stage I patients, the disease recurrence rate was higher in the PD-L1–positive versus in the PD-L1–negative group (48% versus 27%, p < 0.001), with an adjusted hazard ratio for disease-free survival of 2.01 (95% CI, 1.08–3.73; p = 0.03) for strong PD-L1 positivity and 1.57 (95% CI, 1.17–2.11; p = 0.003) for weak PD-L1 positivity compared with PD-L1 negativity.

Conclusions

Tumor PD-L1 expression may be associated with poor prognosis in patients with NSCLC, although its significance weakens when postoperative therapy is considered.

Keywords

Immunomodulation
PD-L1
Laboratory correlates
Molecular diagnosis and prognosis

Cited by (0)

Drs. Sun and Zhou contributed equally to this work.

Disclosure: Drs. Zhou, Wang, Dolled-Filhart, Emancipator, and Wu and an immediate family member are employees of Merck & Co., Inc. Dr. Weiner was an employee of Merck & Co., Inc., at the time this work was completed. The spouse of Dr. Emancipator is employed by Celgene. Dr. Dolled-Filhart, Dr. Wu and an immediate family member, and Dr. Zhou own stock in Merck & Co., Inc. Dr. Emancipator and/or his spouse own stock in Merck & Co., Inc., Bayer AG, Johnson & Johnson, and Celgene. Dr. Frisman is an employee of QualTek Molecular Laboratories, which served as consultant to Merck & Co., Inc. Dr. Wu has a patent or intellectual property with Merck & Co., Inc. Dr. Kim and his institution have received research funding from Merck & Co., Inc. The remaining authors declare no conflict of interest.