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Evaluation of the programmed death-ligand 1 mRNA expression and immunopositivity and their correlation with survival outcomes in Indian lung cancer patients

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Abstract

The presence of membranous immunopositivity of programmed death-ligand 1 (PD-L1) in tumors serves as a key determinant of response to immune checkpoint inhibitors. However, there are very limited studies on the evaluation of the PD-L1 mRNA expression and immunopositivity and their correlation with therapeutic response and survival outcomes, especially in Indian lung cancer patients. In this prospective study, conducted between 2017 and 2020, we collected biopsies and surgically resected tumors from 173 lung cancer patients. PD-L1 immunopositivity and mRNA expression were determined by immunohistochemistry using SP263 assay and qRT–PCR, respectively. PD-L1 expression was correlated with various clinicopathological variables, response to therapy, and survival outcomes using appropriate statistical methods. The median age was 60 years (range 33–81 years) with the majority of patients being male (86.5%) and smokers (83%). Histologically, the majority of patients were non-small cell lung cancer (89.4%) and of squamous cell carcinoma histology (64.3%). PD-L1 immunopositivity in tumor cells (tumor proportion score (TPS) ≥ 1%) was detected in 37.6%, while high immunopositivity (TPS ≥ 50%) was detected in 16.8% of lung cancer patients. Almost 76% of lung cancer patients with PD-L1 TPS ≥ 50% belonged to PD-L1 mRNA high-expression group. PD-L1 mRNA expression and immunopositivity did not correlate with response to therapy and survival outcomes. We conclude that PD-L1 immunopositivity and mRNA expression do not seem to serve as a prognostic biomarker for lung cancer patients treated with chemotherapy. More prospective studies should be planned to evaluate the predictive and prognostic relevance of PD-L1 expression in Indian lung cancer patients being treated with immune checkpoint inhibitors.

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Abbreviations

NSCLC:

Non-small cell lung cancer

SCLC:

Small cell lung cancer

LUSC:

Lung squamous cell carcinoma

LUAD:

Lung adenocarcinoma

RNA:

Ribonucleic acid

mRNA:

Messenger RNA

rRNA:

Ribosomal RNA

qRT–PCR:

Reverse transcription quantitative polymerase chain reaction

OS:

Overall survival

PFS:

Progression-free survival

PD-1:

Programmed cell death protein 1

PD-L1:

Programmed death-ligand 1

ICIs:

Immune checkpoint inhibitors

IHC:

Immunohistochemistry

CT:

Computed tomography

MRI:

Magnetic resonance imaging

TPS:

Tumor proportion score

RECIST:

Response evaluation criteria in solid tumors

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

CTCs:

Circulating tumor cells

EGFR:

Epidermal growth factor receptor

ALK:

Anaplastic lymphoma kinase

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Funding

This study is supported by an extramural research grant from Indian Council of Medical Research (ICMR), New Delhi (Grant No. 5/13/11/2019/NCD-III) and an intramural research grant from All India Institute of Medical Sciences, New Delhi (A-516).

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Authors and Affiliations

  1. Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Sachin Kumar, Monu Pandey, Ishfaq A. Mir, Abhirup Mukhopadhyay, Surender K. Sharawat & Prabhat S. Malik

  2. Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Deepali Jain

  3. Department of Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Jyoutishman Saikia & Sunil Kumar

  4. Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Anant Mohan

  5. Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India

    Monu Pandey

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Contributions

SK, MP, AM, IAM, and DJ performed laboratory experiments. SK and SKS performed data analysis. JS, PSM, SK, and AM provided clinical samples, and epidemiological and survival data. All the authors contributed significantly in the writing of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Sachin Kumar.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by ethics committee of All India Institute of Medical Sciences, New Delhi (Ref. No. IEC-149/07.04.2017, RP-14/2017 and IEC-308/03.05.2019). This article does not contain any studies with animals performed by any of the authors.

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Kumar, S., Pandey, M., Mir, I.A. et al. Evaluation of the programmed death-ligand 1 mRNA expression and immunopositivity and their correlation with survival outcomes in Indian lung cancer patients. Human Cell 35, 286–298 (2022). https://doi.org/10.1007/s13577-021-00647-4

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