Expressions of CD8+TILs, PD-L1 and Foxp3+TILs in stage I NSCLC guiding adjuvant chemotherapy decisions.
OBJECTIVE
Currently, adjuvant chemotherapy is recommended for patients with high risk stage I non-small cell lung cancer (NSCLC). However, identifying high risk patients remains a challenge. This study aims to identify the patient cohorts more likely to benefit from adjuvant chemotherapy based on the tumor micro-immune environment.


RESULTS
CD8+TILs significantly associated with disease-free survival (DFS) and overall survial (OS) (p=0.002; 0.040). Patients with high risk factors may also predict shorter DFS (P=0.056). When compared together, patients with high-CD8+TILs showed better DFS than patients with low-CD8+TILs, no matter their risk factors status. There's no correlation between PD-L1 expressions and survival. PD-L1 was highly expressed in men, squamous and well differentiated carcinoma. In addition, Foxp3+TILs alone didn't show any prognostic effects, but low-Foxp3/high-CD8+TILs were associated with prolonged DFS (p=0.031).


METHODS
A total of 126 patients with surgically resected stage I NSCLC were included to perform immunohistochemistry of CD8+ tumor infiltrating lymphocytes (TILs), programmed death ligand-1(PD-L1) and forkhead box P3 (Foxp3)+TILs.


CONCLUSIONS
CD8+TILs are effective prognostic predictors. Patients with surgically resected stage I NSCLC showing low CD8+TILs could be considered for adjuvant chemotherapy, even if they have no high risk features.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Feifei
F
Teng
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Xiangjiao
X
Meng
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Xin
X
Wang
Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Jupeng
J
Yuan
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Sujing
S
Liu
Department of Pathology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Dianbin
D
Mu
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Hui
H
Zhu
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Li
L
Kong
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China.
Jinming
J
Yu
D000328:Adult; D000368:Aged; D060890:B7-H1 Antigen / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D000066491:Clinical Decision-Making; D018572:Disease-Free Survival; D005260:Female; D051858:Forkhead Transcription Factors / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D016246:Lymphocytes, Tumor-Infiltrating / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D060890:B7-H1 Antigen; D014408:Biomarkers, Tumor; C423236:CD274 protein, human; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors
Foxp3; PD-L1; TILs; adjuvant chemotherapy; non-small cell lung cancer