Prognostic significance of blood-based PD-L1 analysis in patients with non-small cell lung cancer undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis

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Abstract

Background

The main types of PD-L1 in the blood include soluble PD-L1 (sPD-L1), exosomal PD-L1 (exoPD-L1), and PD-L1 in circulating tumor cells (CTCs). However, the predictive and prognostic values of these three indicators in patients with non-small cell lung cancer (NSCLC) undergoing immune checkpoint inhibitor (ICI) therapy are unclear, warranting a systematic meta-analysis.

Methods

A systematic literature search was performed in the PubMed, Cochrane Library, and Embase databases. The pooled hazard ratio (HR) and 95% confidence interval (CI) values were extracted from the included studies to investigate the correlation between the three PD-L1 indicators and overall survival (OS) or progression-free survival (PFS). The Newcastle–Ottawa Scale (NOS) was used to examine the quality of the included studies. Subgroup analyses were employed to investigate the heterogeneity. The publication bias of the included studies was assessed using Begg's and Egger's tests. P < 0.05 was regarded as significantly different.

Results

The pooled results revealed that high pre-treatment sPD-L1 levels were significantly associated with inferior OS (HR = 2.32, 95% CI = 1.68–3.18, P < 0.001) and PFS (HR = 2.52, 95% CI = 1.72–3.68, P < 0.001). However, dynamic changes in sPD-L1 after immunotherapy were not statistically significant for OS (HR = 1.46, 95% CI = 0.65–3.26, P > 0.05) or PFS (HR = 1.62, 95% CI = 0.92–2.86, P > 0.05). Meanwhile, the upregulated pre-treatment exoPD-L1 levels were significantly associated with poor PFS (HR = 4.44, 95% CI = 2.87–6.89, P < 0.001), whereas the post-treatment dynamic upregulation of exoPD-L1 was significantly correlated with superior PFS (HR = 0.36, 95% CI = 0.24–0.54, P < 0.001) and OS (HR = 0.20, 95% CI = 0.07–0.53, P < 0.001). For PD-L1 in CTCs, the pooled results indicated that PD-L1 expression in CTCs was not significantly correlated with OS (HR = 0.75, 95% CI = 0.49–1.13, P = 0.170) and PFS (HR = 0.79, 95% CI = 0.59–1.06, P = 0.12).

Conclusions

Blood-based PD-L1 analysis is a potential strategy for predicting treatment efficacy and prognosis in patients with cancer.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-023-03215-2.

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Most cited references 64

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Author and article information

Contributors

Jianchun Yu: yujianchun1966@163.com

Journal

Journal ID (nlm-ta): World J Surg Oncol

Journal ID (iso-abbrev): World J Surg Oncol

Title: World Journal of Surgical Oncology

Publisher: BioMed Central (London )

ISSN (Electronic): 1477-7819

Publication date (Electronic): 11 October 2023

Publication date PMC-release: 11 October 2023

Publication date Collection: 2023

Volume: 21

Electronic Location Identifier: 318

Affiliations

[1 ]Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, ( https://ror.org/02fsmcz03) Tianjin, China

[2 ]GRID grid.410648.f, ISNI 0000 0001 1816 6218, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, ; Tianjin, China

[3 ]Graduate School, Tianjin University of Traditional Chinese Medicine, ( https://ror.org/05dfcz246) Tianjin, China

Article

Publisher ID: 3215

DOI: 10.1186/s12957-023-03215-2

PMC ID: 10566159

PubMed ID: 37821941

SO-VID: 1f51bf2d-2523-44fa-9a04-8b0302f48bc5

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 24 May 2023

Date accepted : 3 October 2023

Funding

Funded by: Scientific Research Plan Project of Tianjin Education Commission

Award ID: 2018KJ034

Award Recipient : Jianchun Yu

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: non-small cell lung cancer,liquid biopsy,blood-based pd-l1,meta-analysis

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ScienceOpen disciplines: Surgery

Keywords: non-small cell lung cancer, liquid biopsy, blood-based pd-l1, meta-analysis

Prognostic significance of blood-based PD-L1 analysis in patients with non-small cell lung cancer undergoing immune checkpoint inhibitor therapy: a systematic review and meta-analysis

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Most cited references 64

Cancer Statistics, 2021

The blockade of immune checkpoints in cancer immunotherapy.

Pembrolizumab versus Chemotherapy for PD-L1–Positive Non–Small-Cell Lung Cancer

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