Karl Landsteiner University of Health Sciences, Department of General and Thoracic Surgery, University Hospital Krems, Krems an der Donau, Austria.
Karl Landsteiner Society - Institute for Clinical Surgery, Krems an der Donau, Austria.
Sci Rep. 2020 Apr 1;10(1):5784. doi: 10.1038/s41598-020-62813-2.
Malignant pleural effusion (MPE) confers dismal prognosis and has limited treatment options. While immune-checkpoint inhibition (ICI) proved clinical efficacy in a variety of malignancies, data on the prognostic role of PD-L1 in MPE is scarce. We retrospectively studied PD-L1 tumour proportion score and Ki-67 index in pleural biopsies or cytologies from 123 patients (69 lung cancer, 25 mesothelioma, and 29 extrathoracic primary malignancies). Additionally, the impact of C-reactive protein (CRP) and platelet count was also analysed. Median overall survival (OS) after MPE diagnosis was 9 months. Patients with PD-L1 positive tumours (≥1%) had significantly shorter OS than patients with negative PD-L1 status (p = 0.031). CRP and Ki-67 index were also prognostic and remained independent prognosticators after multivariate analysis. Interestingly, Ki-67 index and CRP influenced the prognostic power of PD-L1. Finally, patients receiving ICI tended to have a longer median OS and CRP - but not PD-L1 - was a significant prognosticator in this subgroup. In summary, histological and circulating biomarkers should also be taken into account as potential biomarkers in ICI therapy and they may have an impact on the prognostic power of PD-L1. Our findings might help personalizing immune-checkpoint inhibition for patients with MPE and warrant further prospective validation.
恶性胸腔积液（MPE）预后不良，治疗选择有限。虽然免疫检查点抑制剂（ICI）在多种恶性肿瘤中已证实具有临床疗效，但关于 PD-L1 在 MPE 中的预后作用的数据却很少。我们回顾性研究了 123 名患者（69 名肺癌、25 名间皮瘤和 29 名胸外原发恶性肿瘤）的胸腔活检或细胞学中 PD-L1 肿瘤比例评分和 Ki-67 指数。此外，还分析了 C 反应蛋白（CRP）和血小板计数的影响。MPE 诊断后中位总生存期（OS）为 9 个月。PD-L1 阳性肿瘤（≥1%）患者的 OS 明显短于 PD-L1 阴性状态患者（p=0.031）。CRP 和 Ki-67 指数也是预后因素，且在多变量分析后仍为独立预后因素。有趣的是，Ki-67 指数和 CRP 影响 PD-L1 的预后能力。最后，接受 ICI 治疗的患者中位 OS 较长，且 CRP-而非 PD-L1-是该亚组的显著预后因素。总之，组织学和循环生物标志物也应作为 ICI 治疗的潜在生物标志物加以考虑，它们可能对 PD-L1 的预后能力产生影响。我们的发现可能有助于为 MPE 患者个体化免疫检查点抑制，并需要进一步前瞻性验证。
