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Expression Changes in Programmed Death Ligand 1 from Precancerous Lesions to Invasive Adenocarcinoma in Subcentimeter Pulmonary Nodules: A Large Study of 2022 Cases in China

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

This large-scale, multicenter, retrospective observational study aimed to evaluate the clinicopathological and molecular profiles associated with programmed death-ligand 1 (PD-L1) expression in precancerous lesions and invasive adenocarcinoma in subcentimeter pulmonary nodules.

Patients and Methods

Patients with histologically confirmed atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (ADC) were included. PD-L1 expression was evaluated at each center using a PD-L1 immunohistochemistry 22C3 pharmDx kit (Agilent, Santa Clara, CA, USA). The tumor proportion score (TPS) cutoff values were set at ≥ 1% and ≥ 50%.

Results

A total of 2022 nodules from 1844 patients were analyzed. Of these, 9 (0.45%) nodules had PD-L1 TPS ≥ 50%, 187 (9.25%) had PD-L1 TPS 1–49%, and 1826 (90.30%) had PD-L1 TPS < 1%. A total of 378 (18.69%), 1016 (50.25%), and 628 (31.06%) nodules were diagnosed as AAH/AIS, MIA, and ADC, respectively, by pathology. A total of 1377 (68.10%), 591 (25.67%), and 54 (2.67%) nodules were diagnosed as pure ground-glass opacity (GGO), mixed GGO, and solid nodules, respectively, by computed tomography. There was a significant difference between PD-L1 expression and anaplastic lymphoma kinase (ALK) mutation status (P < 0.001). PD-L1 expression levels were significantly different from those determined using the International Association for the Study of Lung Cancer (IASLC) grading system (P < 0.001).

Conclusions

PD-L1 expression was significantly associated with radiological and pathological invasiveness and driver mutation status in subcentimeter pulmonary nodules. The significance of PD-L1 expression in the evolution of early-stage lung adenocarcinoma requires further investigation.

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Availability of Data and Materials

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

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Acknowledgements

We thank our colleagues in the departments of radiology and pathology for their detailed diagnostic reports. We would like to thank Editage (www.editage.cn) for English language editing.

Funding

This work was supported by the National Natural Science Foundation of China (81872510); Guangdong Provincial People’s Hospital Young Talent Project (GDPPHYTP201902); High-level Hospital Construction Project (DFJH201801); GDPH Scientific Research Funds for Leading Medical Talents and Distinguished Young Scholars in Guangdong Province (No. KJ012019449); Guangdong Basic and Applied Basic Research Foundation (No. 2019B1515130002).

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Authors and Affiliations

  1. School of Medicine, South China University of Technology, Guangzhou, China

    Xiongwen Yang MD, PhD, Zhen-bin Qiu MD, Yi-fan Qi MD & Wen-Zhao Zhong MD, PhD

  2. Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China

    Xiongwen Yang MD, PhD, Zhen-bin Qiu MD, Yi-fan Qi MD, Meng-min Wang MD, Yi-Long Wu MD, PhD & Wen-Zhao Zhong MD, PhD

  3. Department of Cardio-Thoracic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China

    Yi Xiao MD

  4. Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangdong, China

    Hao Hu MD

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Yang, X., Xiao, Y., Hu, H. et al. Expression Changes in Programmed Death Ligand 1 from Precancerous Lesions to Invasive Adenocarcinoma in Subcentimeter Pulmonary Nodules: A Large Study of 2022 Cases in China. Ann Surg Oncol 30, 7400–7411 (2023). https://doi.org/10.1245/s10434-023-14009-x

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