Intrinsic impacts of the expression of PD-L1 on postoperative recurrence in -mutated lung adenocarcinoma.

OBJECTIVES

This study aimed to assess the intrinsic impacts of the expression of PD-L1 on postoperative recurrence and the prognosis in patients with ()-mutated lung adenocarcinomas.

PATIENTS AND METHODS

Data from 221 surgically resected pathological stage IA-IIIA lung adenocarcinomas, collected between 2017 and 2019, were analyzed. This included measurements of mutations and the PD-L1 expression. Recurrence-free survival (RFS) and overall survival (OS) were estimated using a Kaplan-Meier analysis and log-rank test. The independent risk factors for RFS were assessed using univariate and multivariate analyses.

RESULTS

Among the patients, 140 were PD-L1-negative (<1%), while 81 were PD-L1-positive (≥1%). PD-L1 positivity was significantly associated with male sex (p=0.038), smoking habit (p=0.005), ND2 lymph node dissection (p=0.013), higher malignant subtype (p=0.003), higher histological grade (p=0.001), and advanced pathological stage (p=0.004). Conversely, mutations were more common in the PD-L1-negative group than in the PD-L1-positive group (p=0.006). Patients were categorized into four groups based on their mutation status and PD-L1 expression status: PD-L1-positive (≥1%) with or without mutations ((+)/PD-L1≥1% or -)/PD-L1≥1%), and PD-L1-negative (<1%) with or without mutations ((+)/PD-L1<1% or -)/PD-L1<1%). Among these groups, (+)/PD-L1≥1% cases exhibited the worst 5-year RFS (log-rank, p=0.010), while there was no significant difference in 5-year OS (log-rank, p=0.122). Furthermore, a multivariate analysis revealed that PD-L1 positivity was an independent significant factor for RFS in -mutated lung adenocarcinoma (p=0.013).

CONCLUSION

PD-L1 positivity emerged as an independent risk factor for RFS in patients with -mutant resected lung adenocarcinoma. These findings may provide valuable insights into the prognostic impact of PD-L1 expression and guide the implementation of postoperative adjuvant therapy in this patient population.