The daily practice reality of PD‑L1 (CD274) evaluation in non‑small cell lung cancer: A retrospective study

Verocq,Camille; Decaestecker,Christine; Rocq,Laureen; De Clercq,Sarah; Verrellen,Audrey; Mekinda,Zita; Ocak,Sebahat; Compère,Christophe; Stanciu‑Pop,Claudia; Salmon,Isabelle; Remmelink,Myriam; D'Haene,Nicky

doi:10.3892/ol.2020.11458

The daily practice reality of PD‑L1 (CD274) evaluation in non‑small cell lung cancer: A retrospective study

Authors:
- Camille Verocq
- Christine Decaestecker
- Laureen Rocq
- Sarah De Clercq
- Audrey Verrellen
- Zita Mekinda
- Sebahat Ocak
- Christophe Compère
- Claudia Stanciu‑Pop
- Isabelle Salmon
- Myriam Remmelink
- Nicky D'Haene
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Affiliations: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium, DIAPath‑Center for Microscopy and Molecular Imaging, ULB, 6041 Gosselies, Belgium, Department of Pulmonology, Erasme Hospital, ULB, 1070 Brussels, Belgium, Division of Pulmonology, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur (Godinne Site), UCL, 5530 Yvoir, Belgium, Department of Pulmonology, Centre Hospitalier Inter Régional Edith Cavell Cancer Institute, 1160 Brussels, Belgium, Department of Pathology, CHU UCL Namur (Godinne Site), UCL, 5530 Yvoir, Belgium
Published online on: March 12, 2020 https://doi.org/10.3892/ol.2020.11458
Pages: 3400-3410
Copyright : © Verocq et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

Treatment with pembrolizumab, an anti-programmed cell death-1 (PDCD-1) monoclonal antibody for the treatment of non‑small cell lung cancers (NSCLCs) requires prior immunohistochemical (IHC) analysis of the expression of the programmed death‑ligand 1 (PD‑L1) (also known as CD274 molecule) which is a heterogeneous and complex marker. The present study aimed to investigate how pathological and technical factors (such as tumor location and sampling type, respectively) may affect the PD‑L1 evaluation in patients with NSCLC in the daily practice of pathology laboratories. The current study was retrospective, and included 454 patients with NSCLC, for whom PD‑L1 expression analysis by IHC was prospectively performed between November 2016 and January 2018. The association between PD‑L1 expression and the clinicopathological characteristics of patients was statistically investigated using either the χ2 and Fisher exact tests or the Mann‑Whitney and Kruskal‑Wallis tests, depending on whether PD‑L1 expression was assessed in three large categories (<1, 1‑49, ≥50%) or in more precise percentages. Furthermore, the same statistical methodology was used to analyze the heterogeneity of PD‑L1 expression according to its sampling type (cytology, biopsy or surgical specimen) and its location (primary tumor, lymph node or distant metastasis). Intra‑ and inter‑observer discrepancies were also studied using double‑blind evaluation and concordance analyses based on the weighted κ coefficient. The results demonstrated a significant association between PD‑L1 expression and sample location (P=0.005), histological type (P=0.026), total number of mutations (P=0.004) and KRAS proto‑oncogene, GTPase mutations (P=0.024). In addition, sampling type did not influence PD‑L1 expression. The inter‑ and intra‑observer discrepancies were 15% and between 16 and 17.5%, respectively. The present study confirmed that evaluation of PD‑L1 expression by IHC can be performed on all types of samples. In addition, the results from the current study highlighted the heterogeneity of PD‑L1 expression among the different types of sample location. In complex cases, a second evaluation of PD‑L1 expression by IHC would be performed due to intra‑ and inter‑observer discrepancies.

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