PD-L1 Expression in Metastatic Lymph Nodes of NSCLC and Its Impact on First-line TKI or Chemotherapy Outcomes
10.11714/jsysu.med.YX20250181
- VernacularTitle:NSCLC转移淋巴结PD-L1表达分析及对一线TKI或化疗结局的影响
- Author:
Zhi XIE
1
;
Zhiyi LÜ
1
;
Danxia LU
1
;
Shuilian ZHANG
1
;
Weibang GUO
1
;
Xue PAN
1
;
Xuchao ZHANG
1
;
Xuening YANG
1
Author Information
1. Medical Research 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 510080， China
- Publication Type:Journal Article
- Keywords:
lung neoplasms;
PD-L1;
lymph node metastasis;
chemotherapy;
tyrosine kinase inhibitors
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2026;47(2):269-282
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo investigate the heterogeneity of PD-L1 expression profiles between primary tumors and paired metastatic lymph nodes in advanced non-small cell lung cancer （NSCLC）， and to determine the predictive value of key immune marker expression for the efficacy of first-line targeted therapy and chemotherapy. MethodsA retrospective analysis was conducted on 128 patients with histologically confirmed NSCLC and corresponding metastatic lymph nodes， who received first-line tyrosine kinase inhibitors （TKIs） or platinum-based doublet chemotherapy at Guangdong Provincial People's Hospital between April 2017 and February 2020. Immunohistochemistry （IHC） was employed to evaluate PD-L1 expression in primary tumors and metastatic lymph nodes. The Wilcoxon signed-rank test was performed to compare PD-L1 expression characteristics between primary tumors and metastatic lymph nodes. Kaplan-Meier survival curves were constructed， and the Log-rank test was used to compare differences between groups. ResultsAmong 28 paired cases， PD-L1 expression levels were numerically higher in metastatic lymph nodes than in primary NSCLC tumors （median：32.5 vs. 10.0）， although the difference did not reach statistical significance （MD = 5.000， P = 0.083）. Survival analysis revealed that in patients with driver gene-positive NSCLC， high PD-L1 expression （TPS ≥ 50%） in lymph nodes was significantly associated with shorter progression-free survival （PFS） following first-line TKI therapy ［median PFS：4.0（TPS≥50%） vs. 8.9（1%≤TPS＜50%） vs. 18.0 （TPS＜1%） months， χ2=15.284， P＜0.001］. Conversely， in patients with driver gene-negative NSCLC， high PD-L1 expression in lymph nodes was associated with longer PFS ［median PFS：7.9 （TPS≥50%） vs. 3.0 （1%≤TPS＜50%）months， χ2=8.436， P=0.004］ and overall survival （OS） ［median OS：28.8 （TPS≥50%） vs. 14.2 （ 1%≤TPS＜50%） months， χ2=4.010， P=0.045］ after first-line chemotherapy. ConclusionPD-L1 expression in metastatic lymph nodes is largely consistent with that in primary tumors of patients with advanced NSCLC. High PD-L1 expression in lymph nodes is associated with improved survival outcomes in driver gene-negative patients undergoing chemotherapy， whereas it portends a poor prognosis with TKI treatment in driver gene-positive patients. These findings support the application of PD-L1 expression levels in metastatic lymph nodes to guide personalized precision medicine strategies for advanced NSCLC.
