Department of Chest Diseases, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, Turkey.
Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey.
J Thromb Thrombolysis. 2023 Feb;55(2):382-391. doi: 10.1007/s11239-022-02753-y. Epub 2022 Dec 24.
The risk of venous thromboembolism (VTE) is increased in non-small cell lung cancer (NSCLC), and defining at-risk patients is important. Thus, we aimed to assess the association between programmed cell death ligand 1 (PD-L1) expression and VTE [pulmonary embolism (PE), deep venous thrombosis (DVT)] in NSCLC. In this retrospective, observational multicentre study, 369 patients with NSCLC who had PD-L1 immunohistochemistry based on biopsies taken between January 2017 and December 2019, were divided as PD-L1-positive (n = 181) and -negative (n = 188) groups, and low-positive (n = 99) and high-positive (n = 82) PD-L1 groups. Among all population, 12.5% of them developed a VTE during a median follow-up of 474 days. The rates of DVT, PE, and PE + DVT were 5.7%, 6% and 0.8%, respectively. VTE (15.5% vs. 9.5%) and DVT (3.8% vs. 7.4%) were similar between two groups, while PE was significantly higher in PD‑L1-positive group than those in PD-L1-negative group (11.1% vs 1%, p < 0.001). There were no significant differences between low- and high-positive groups in terms of VTE (14.1% vs. 17%), PE (12.1% vs. 9.8%), and DVT (2% vs. 6.1%). In the multivariate analysis, multiple metastases (Hazard ratio [HR] 4.02; 95% confidence interval [Cl] 1.18-13.63; p = 0.07) and PD-L1 positivity was associated with an increased PE risk (HR 8.39; 95% Cl 2.07-34.07; p = 0.003). In conclusion, PD-L1 positivity may be of important role in predicting the increased risk of PE in patients with NSCLC and thereby may be used to define patients likely to benefit from thromboprophylaxis.
非小细胞肺癌（NSCLC）患者静脉血栓栓塞症（VTE）的风险增加，明确高危患者很重要。因此，我们旨在评估程序性死亡配体 1（PD-L1）表达与 NSCLC 患者 VTE（肺栓塞（PE）、深静脉血栓形成（DVT））之间的相关性。在这项回顾性、观察性多中心研究中，我们将 369 例 2017 年 1 月至 2019 年 12 月期间基于活检进行 PD-L1 免疫组化的 NSCLC 患者分为 PD-L1 阳性（n=181）和阴性（n=188）组、低阳性（n=99）和高阳性（n=82）PD-L1 组。在所有患者中，12.5%的患者在中位随访 474 天后发生 VTE。DVT、PE 和 PE+DVT 的发生率分别为 5.7%、6%和 0.8%。PD-L1 阳性组的 VTE（15.5% vs. 9.5%）和 DVT（3.8% vs. 7.4%）与 PD-L1 阴性组相似，而 PE 显著高于 PD-L1 阴性组（11.1% vs. 1%，p<0.001）。低阳性组和高阳性组在 VTE（14.1% vs. 17%）、PE（12.1% vs. 9.8%）和 DVT（2% vs. 6.1%）方面没有显著差异。多变量分析显示，多发转移（风险比[HR] 4.02；95%置信区间[Cl] 1.18-13.63；p=0.07）和 PD-L1 阳性与 PE 风险增加相关（HR 8.39；95% Cl 2.07-34.07；p=0.003）。总之，PD-L1 阳性可能对预测 NSCLC 患者 PE 风险增加具有重要作用，因此可能用于定义可能从血栓预防中受益的患者。
