ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The prognostic significance of PD-1 and its ligands in non-small cell lung cancer
Ozan Usluer1, Özde Elif Gökbayrak2, Aylin Erol2, Tekincan Çağrı Aktaş2, Güntuğ Batıhan3, Şeyda Örs Kaya1, Ahmet Üçvet1, Zekiye Aydoğdu3, Zekiye Altun2, İlhan Öztop4, Safiye Aktaş2
1Department of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
2Department of Basic Oncology, Dokuz Eylül University, Institute of Health Sciences, Izmir, Türkiye
3Department of Thoracic Surgery, Kars Harakani State Hospital, Kars, Türkiye
4Department of Pathology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
5Department of Medical Oncology, Dokuz Eylül University, Oncology Institute, Izmir, Türkiye
DOI : 10.5606/tgkdc.dergisi.2024.25394
Background: In this study, we aimed to investigate the prognostic value of programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), and programmed cell death ligand 2 (PD-L2) expressions on immune and cancer cells in terms of survival in patients with lung adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Methods: Between January 2000 and December 2012, a total of 191 patients (172 males, 19 females; mean age: 60.3±8.4 years; range, 38 to 78 years) who were diagnosed with non-small cell lung cancer and underwent anatomic resection and mediastinal lymph node dissection were retrospectively analyzed. The patients were evaluated in three groups including lung squamous cell carcinoma (n=61), adenocarcinoma (n=66), and large-cell carcinoma (n=64). The survival rates of all three groups were compared in terms of immunohistochemical expression levels of PD-1, PD-L1, and PD-L2.

Results: The mean follow-up was 71.8±47.9 months. In all histological subtypes, PD-1 expressions on tumor and immune cells were observed in 33% (61/191) and in 53.1% (102/191) of the patients, respectively. Higher expression levels of PD-L1 and PD-L2 at any intensity on tumor and immune cells were defined only in lung adenocarcinomas, and PD-L1 and PD-L2 values were detected in 36.4% (22/64) of these patients. The PD-L1 expressions on tumor and immune cells were observed in 41.7% (10/24) and 25% (6/24) of the patients, respectively. The PD-L2 expressions on tumor and immune cells were detected in 16.7% (4/24) and 8.4% (2/24) of the patients, respectively. Univariate and multivariate analyses revealed that PD-1 expression in tumor cells was an independent prognostic factor in all histological subtypes.

Conclusion: Our study results suggest that PD-1 expression is a poor prognostic factor for overall survival in patients with completely resected adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Keywords : Non-small cell lung cancer, prognosis, programmed cell death ligand 1, programmed cell death ligand 2, programmed cell death protein 1, survival
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