| Objective: As anti-programmed death ligand 1(PD-L1)antibody and anti-programmed cell death 1(PD-1)therapy have astonishingly approved survival of NSCLC patients,it is urgent to identify a predictive marker of the curative effect and prognosis of PD-L1/PD-1 antibody treatment.Some scholars suggested that it might be the expression of PD-L1,but there was no consistent conclusion made by correlational research.This studyfocused on PD-L1 expression and its association with clinicopathologic factors,including PD-1 expression on lymphocyte and CD3+T cell infiltration,EGFR mutation status,and its prognosis value in NSCLC patients.A study proved that PD-L1 could regulate the glycolytic enzymes,and directly affect tumor metabolism.Hence the question arises that if PD-L1 expression has an impact on maximum standard uptake value(SUV-max).The study will further explore the association between the expression of PD-L1 and SUV-max in tumor.Methods:The information of 122 NSCLC patients was collected from Tianjin Medical University Cancer Institute and Hospital from April 2008 to August 2014.PD-L1 expression,lymphocyte PD-1 and CD3+T cell infiltration were assessed by immunohistochemistry in all surgically resected non-small cell lung carcinoma tissue.The association between PD-L1 expression and clinical factors was analyzed using x~2 test and kruskal-wallis test.Correlation between PD-L1 and molecular markers,SUV-max and EGFR mutation status was analyzed by Pearson analysis and Spearman rank analysis.Survival was analyzed using the Kaplan-Meier method and multivariate Cox proportional hazards model.Results: The positive rate of 122 NSCLC patients' primary tumor PD-L1 expression was 59%.PD-L1 expression was divided into three groups according to the median positive percentage15.4%(0%-93.2%),including negative group(50 cases),low expression group(36 cases)and high expression group(36 cases).PD-L1 was positively correlated with TNM staging(r=0.273,P=0.002),and PD-L1 expression was different in distinct stage of TNM(P=0.003).PD-L1 expression was of no significant difference in sex,age,smoking status,tumor size,histological type and the level of CEA.SUV-max was divided into twogroup according to the ROC curve cutting-off 10.6.PD-L1 expression was not related with SUV-max.There was no significant association between PD-L1 expression and CD3+T cell infiltration in primary tumor.Neither the association between PD-L1 and lymphocyte PD-1 expression nor PD-L1 and EGFR mutation status.PD-L1 expression in primary tumor cell was not related to that in the corresponding metastasis lymph node.In order to avoid the interference of TNM staging in the PD-L1 prognosis analysis,122 NSCLC patients' survival analysis was divided into two groups.Multivariate analysis revealed that PD-L1 expression(HR=4.518,95%CI: 1.176-17.352,P=0.028)and tumor size(HR=1.404,95%CI: 1.020-1.933,P=0.037)were independent risk factors for overall survival(OS)in early NSCLC patients.Gender,age,pathological type,the level of CEA and SUV-max group had no obvious effect on them.Gender,pathological type,tumor size and SUV-max group affect OS in III – IV NSCLC patients.But age,CEA level and PD-L1 expression had no effect on OS.PD-L1 expression was not an independent risk factor for OS in III – IV NSCLC patients.The SUV-max group had no association with PD-L1 in all patients.Conclusion: PD-L1 expression differs in distinct stage of TNM.There was no correlation between PD-L1 expression in NSCLC primary tumor cell and clinical factors including SUV-max,CD3+T cell infiiltration,lymphocyte PD-1 and EGFR mutation status.The expression of PD-L1 in primary tumor cell and metastasis lymph node had no association.This may be due to the following reasons: the difference of PD-L1 detection methods,the lack of an international standard of evaluation,PD-L1 expression mechanism has not yet been elucidated,and tumor heterogeneity.The expression of PD-L1 was an independent risk factor for OS in early NSCLC patients. |
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