Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Department of Thoracic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Thorac Cancer. 2024 Nov;15(31):2229-2234. doi: 10.1111/1759-7714.15453. Epub 2024 Sep 19.
Superior outcomes have been obtained for neoadjuvant treatment with immune checkpoint inhibitors (ICI) plus chemotherapy over neoadjuvant chemotherapy alone, especially in patients with high programmed cell death ligand 1 (PD-L1) expression. However, it is not always possible to obtain sufficient tumor specimens for biomarker testing before surgery. In this study, we explored clinical factors that can predict high PD-L1 expression.
We retrospectively enrolled 340 lung cancer patients who received pulmonary resection between 2014 and 2023 and who had PD-L1 expression data. Chi-squared tests and logistic regression analyses were used to identify clinical factors associated with high PD-L1 status.
Univariable and multivariable analyses revealed that smoking, high maximum standardized uptake value (SUVmax) of 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT), and high plasma fibrinogen are independent predictors of high PD-L1 expression. A predictive score for high PD-L1 expression (ranging from 0 to 3) was developed based on these parameters. Notably, only 5% of patients with a score of 0 exhibited high PD-L1 expression, whereas this proportion increased to 53% for patients with a score of 3.
These results showed that plasma fibrinogen, smoking history, and SUVmax are predictors of high PD-L1 expression, providing a basis for identifying patients expected to benefit from neoadjuvant ICI treatment.
与单独新辅助化疗相比，免疫检查点抑制剂（ICI）联合化疗的新辅助治疗已获得更好的结果，尤其是在高程序性死亡配体 1（PD-L1）表达的患者中。然而，在手术前并非总能获得足够的肿瘤标本进行生物标志物检测。在本研究中，我们探讨了可以预测高 PD-L1 表达的临床因素。
我们回顾性纳入了 2014 年至 2023 年间接受肺切除术且具有 PD-L1 表达数据的 340 例肺癌患者。采用卡方检验和逻辑回归分析来识别与高 PD-L1 状态相关的临床因素。
单变量和多变量分析表明，吸烟、18F-氟脱氧葡萄糖正电子发射断层扫描（18F-FDG PET/CT）的最大标准化摄取值（SUVmax）高和血浆纤维蛋白原高是高 PD-L1 表达的独立预测因素。基于这些参数，我们开发了一个用于预测高 PD-L1 表达的评分（范围为 0 至 3）。值得注意的是，评分 0 的患者中仅有 5%表现出高 PD-L1 表达，而评分 3 的患者中这一比例增加到 53%。
这些结果表明，血浆纤维蛋白原、吸烟史和 SUVmax 是高 PD-L1 表达的预测因素，为识别有望从新辅助 ICI 治疗中获益的患者提供了依据。
