Tao Shi1, Shuai Zhu2, Hengjuan Guo3, Xiongfei Li2, Shikang Zhao2, Yanye Wang2, Xi Lei2, Dingzhi Huang4, Ling Peng5, Ziming Li6, Song Xu2. 1. Precision Medicine Center, Tianjin Medical University General Hospital, Tianjin, China. 2. Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China. 3. Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, China. 4. Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China. 5. Department of Radiotherapy, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 6. Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Abstract
INTRODUCTION: Previous studies have demonstrated that programmed cell death-ligand 1 (PD-L1) serves as biomarker for poor prognosis and survival in advanced-stage non-small cell lung cancer (NSCLC) patients. However, the merit of PD-L1 expression to predict the prognosis of early stage NSCLC patients who underwent complete resection remains controversial. In the present study, we performed a meta-analysis to investigate the relationship between PD-L1 expression and prognosis in patients with early stage resected NSCLC. METHODS: Electronic databases, including PubMed, EMBASE, and the Cochrane Library, were searched until July 23 2020 for studies evaluating the expression of PD-L1 and the prognosis of resected NSCLCs. Hazard ratios (HRs) with 95% confidence intervals (CIs) of overall survival (OS) and disease-free survival (DFS) were pooled and analyzed. Heterogeneity and publication bias analyses were also assessed. RESULTS: A total of 15 studies involving 3,790 patients were considered in the present meta-analysis. The pooled HR indicated that PD-L1 expression related to a much shorter DFS (HR = 1.56, 95% CI: 1.18-2.05, p < 0.01), as well a significantly worse OS (HR = 1.68, 95% CI: 1.29-2.18, p < 0.01). Furthermore, our analysis indicated that PD-L1 expression was significantly associated with gender (male vs. female: OR = 1.27, 95% CI:1.01-1.59, p = 0.038), histology (ADC vs. SCC: OR = 0.54, 95% CI:0.38-0.77, p = 0.001), TNM stage (I vs. II-III: OR = 0.45, 95% CI:0.34-0.60, p = 0.000), smoking status (Yes vs No: OR = 1.43, 95% CI:1.14-1.80, p = 0.002) and lymph node metastasis (N+ vs N-: OR = 1.97, 95% CI:1.26-3.08, p = 0.003). CONCLUSIONS: The results of this meta-analysis suggest that PD-L1 expression predicts an unfavorable prognosis in early stage resected NSCLCs. The role of personalized anti-PD-L1/PD-1 immunotherapy in the adjuvant settings of resected NSCLC warrants further investigation.
INTRODUCTION: Previous studies have demonstrated that programmed cell death-ligand 1 (PD-L1) serves as biomarker for poor prognosis and survival in advanced-stage non-small cell lung cancer (NSCLC) patients. However, the merit of PD-L1 expression to predict the prognosis of early stage NSCLC patients who underwent complete resection remains controversial. In the present study, we performed a meta-analysis to investigate the relationship between PD-L1 expression and prognosis in patients with early stage resected NSCLC. METHODS: Electronic databases, including PubMed, EMBASE, and the Cochrane Library, were searched until July 23 2020 for studies evaluating the expression of PD-L1 and the prognosis of resected NSCLCs. Hazard ratios (HRs) with 95% confidence intervals (CIs) of overall survival (OS) and disease-free survival (DFS) were pooled and analyzed. Heterogeneity and publication bias analyses were also assessed. RESULTS: A total of 15 studies involving 3,790 patients were considered in the present meta-analysis. The pooled HR indicated that PD-L1 expression related to a much shorter DFS (HR = 1.56, 95% CI: 1.18-2.05, p < 0.01), as well a significantly worse OS (HR = 1.68, 95% CI: 1.29-2.18, p < 0.01). Furthermore, our analysis indicated that PD-L1 expression was significantly associated with gender (male vs. female: OR = 1.27, 95% CI:1.01-1.59, p = 0.038), histology (ADC vs. SCC: OR = 0.54, 95% CI:0.38-0.77, p = 0.001), TNM stage (I vs. II-III: OR = 0.45, 95% CI:0.34-0.60, p = 0.000), smoking status (Yes vs No: OR = 1.43, 95% CI:1.14-1.80, p = 0.002) and lymph node metastasis (N+ vs N-: OR = 1.97, 95% CI:1.26-3.08, p = 0.003). CONCLUSIONS: The results of this meta-analysis suggest that PD-L1 expression predicts an unfavorable prognosis in early stage resected NSCLCs. The role of personalized anti-PD-L1/PD-1 immunotherapy in the adjuvant settings of resected NSCLC warrants further investigation.
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