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. 2023 Nov 14;23(1):1107.
doi: 10.1186/s12885-023-11604-9.

The combination of PD-L1 expression and the neutrophil-to-lymphocyte ratio as a prognostic factor of postoperative recurrence in non-small-cell lung cancer: a retrospective cohort study

Hironobu Samejima  1 , Kensuke Kojima  2 , Ayako Fujiwara  1 , Toshiteru Tokunaga  1 , Kyoichi Okishio  3   4 , Hyungeun Yoon  1
Affiliations

The combination of PD-L1 expression and the neutrophil-to-lymphocyte ratio as a prognostic factor of postoperative recurrence in non-small-cell lung cancer: a retrospective cohort study

Hironobu Samejima et al. BMC Cancer. .

Abstract

Background: While PD-L1 expression and neutrophil-to-lymphocyte ratio (NLR) are prognostic biomarkers for lung cancer, few studies have considered their interaction. We hypothesized that the product of PD-L1 expression (tumor proportion score) and the NLR (PD-L1 × NLR) might be a postoperative prognostic marker reflecting the immune microenvironment of lung cancer.

Methods: We analyzed the association between PD-L1 × NLR and postoperative recurrence-free survival in 647 patients with NSCLC using multivariable Cox proportional hazards models.

Results: In the analysis of PD-L1 × NLR as a categorical variable, the group with PD-L1 × NLR ≥ 25.8 had a significantly higher hazard ratio (HR) than the group with < 25.8 (adjusted HR 1.78, 95% confidence interval [CI] 1.23-2.60). The adjusted HR for PD-L1 × NLR, considered a continuous variable, was 1.004 (95% CI, 1.002-1.006). The risk of postoperative recurrence increased by 1.004-fold for each unit increase in PD-L1 × NLR, and a more than 2-fold increase in risk was observed for values ≥ 170.

Conclusions: PD-L1 × NLR may be used in real-world clinical practice as a novel factor for predicting the risk of postoperative recurrence after lung cancer surgery.

Keywords: Multivariable Cox proportional analysis; Neutrophil-to-lymphocyte ratio; Programmed death-ligand 1; Recurrence-free survival.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves showing the probability of recurrence-free survival among patients after surgery according to the value of PD-L1 × NLR. NLR neutrophil-to-lymphocyte ratio, PD-L1 programmed cell death-ligand 1
Fig. 2
Fig. 2
Hazard ratios of postoperative recurrence-free survival for each increase in the value of PD-L1 × NLR. The hazard ratio (y) for each value of PD-L1 × NLR to the range of increase from the value (x) was calculated based on the result of a multivariable Cox proportional hazards analysis. The hazard ratio for the regression coefficient (β) in this multivariable analysis was given by the value of eβ, i.e., 1.004. The function y was given by y = eβx
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