Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Huaihai West Road No.241, Shanghai, 200030, China.
Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Middle Road No.301, Shanghai, 200072, China.
Respir Res. 2024 Jun 5;25(1):233. doi: 10.1186/s12931-024-02858-3.
There is inconclusive evidence to suggest that the expression of programmed cell death ligand 1 (PD-L1) is a putative predictor of response to EGFR-TKI therapy in advanced EGFR-mutant non-small cell lung cancer (NSCLC). We evaluated the heterogeneity in PD-L1 expression in the primary lung site and metastatic lymph nodes to analyze the association between PD-L1 expression and response for patients treated with EGFR-TKI.
This study reviewed 184 advanced NSCLC patients with EGFR mutations who received first-generation EGFR-TKI as first-line treatment from 2020 to 2021 at Shanghai Chest Hospital. The patients were divided into the primary lung site group (n = 100) and the metastatic lymph nodes group (n = 84) according to the biopsy site. The patients in each group were divided into TPS < 1%, TPS 1-49%, and TPS ≥ 50% groups according to PD-L1 expression.
The median PFS was 7 (95% CI: 5.7-8.3) months, and the median OS was 26 (95% CI: 23.5-28.5) months for all patients. No correlation existed between PFS or OS and PD-L1 expression. The median PFS in the primary lung site group was 11 months (95% CI: 9.6-12.4) in the TPS < 1% group, 8 months (95% CI: 6.6-9.4) in TPS 1-49% group, and 4 months (95% CI: 3.2-4.8) in TPS ≥ 50% group, with statistically significant differences (p = 0.000). The median OS of the TPS < 1% group and TPS ≥ 50% group showed a statistically significant difference (p = 0.008) in the primary lung site group. In contrast, PD-L1 expression in the lymph nodes of EGFR-mutant patients was unrelated to PFS or OS after EGFR-TKI therapy.
PD-L1 expression from the primary lung site might predict clinical benefit from EGFR-TKI, whereas PD-L1 from metastatic lymph nodes did not.
This retrospective study was approved by the Ethics Committee of Shanghai Chest Hospital (ID: IS23060) and performed following the Helsinki Declaration of 1964 (revised 2008).
有不确定的证据表明，程序性死亡配体 1（PD-L1）的表达是预测表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗晚期表皮生长因子受体突变型非小细胞肺癌（NSCLC）疗效的一个潜在指标。我们评估了原发肺部和转移性淋巴结中 PD-L1 表达的异质性，以分析 PD-L1 表达与接受 EGFR-TKI 治疗的患者反应之间的关系。
本研究回顾性分析了 2020 年至 2021 年在上海胸科医院接受第一代 EGFR-TKI 作为一线治疗的 184 例 EGFR 突变的晚期 NSCLC 患者。根据活检部位，患者分为原发肺部组（n=100）和转移性淋巴结组（n=84）。根据 PD-L1 表达，每组患者又分为 TPS<1%、TPS1-49%和 TPS≥50%组。
所有患者的中位无进展生存期（PFS）为 7 个月（95%CI：5.7-8.3），中位总生存期（OS）为 26 个月（95%CI：23.5-28.5）。PFS 或 OS 与 PD-L1 表达无相关性。原发肺部组 TPS<1%组的中位 PFS 为 11 个月（95%CI：9.6-12.4），TPS1-49%组为 8 个月（95%CI：6.6-9.4），TPS≥50%组为 4 个月（95%CI：3.2-4.8），差异有统计学意义（p=0.000）。TPS<1%组和 TPS≥50%组的中位 OS 差异有统计学意义（p=0.008）。相比之下，EGFR 突变患者淋巴结中的 PD-L1 表达与 EGFR-TKI 治疗后的 PFS 或 OS 无关。
来自原发肺部的 PD-L1 表达可能预测 EGFR-TKI 的临床获益，而来自转移淋巴结的 PD-L1 表达则不能。
本回顾性研究得到了上海胸科医院伦理委员会的批准（编号：IS23060），并遵循了 1964 年修订的赫尔辛基宣言。
