Consistency Analysis of Programmed Death-Ligand 1 Expression between Primary and Metastatic Non-Small Cell Lung Cancer: A Retrospective Study

Background: Programmed death-ligand 1 (PD-L1) expression in non-small cell lung cancer (NSCLC) is considered as a predictive biomarker of anti-PD-1/PD-L1 cancer therapies. However, the correlation of PD-L1 expression status between the primary and paired metastatic NSCLC is still not clear. The current study aims to address this specific issue. Materials and Methods: The PD-L1 expression of the primary and paired metastatic lesions from 110 patients with NSCLC was retrospectively evaluated by immunohistochemical assay using Anti-PD-L1 antibody, Clone 22C3. The results were assessed by the Tumor Proportion Score (TPS) using cutoff values of <1%, 1%-49% and ≥50%. Meanwhile, the Cohen's kappa coefficient (k) of agreement was calculated. Results: An overall concordance rate of the PD-L1 expression between the primary and metastatic lesions was 61% (63/103) (k = 0.39, and P < 0.001). If using TPS considering 1% and 50% as a threshold, the inconsistent rate was 28/103 (27.2%) paired specimens (k = 0.46, and P < 0.001) and 14/103 (13.6%) paired specimens (k = 0.53, and P < 0.001), respectively. Moreover, the concordance of the PD-L1 expression between primary and metastatic tumor was also analyzed according to the clinical stages within the untreated group of patients. We observed that for patients with stage I-III NSCLC, the concordance rate of the PD-L1 expression between primary and metastatic lesions was 81.3% and 100% when using 1% and 50% as threshold, respectively. While in stage IV patients, the concordance rate of the PD-L1 expression between the primary and metastatic lesions drops to 71.4% and 85.7%, respectively. Conclusion: The PD-L1 expression was dynamic as tumor developed, which was valuable in selecting the proper type of sample for accurately evaluating the prognosis of using pembrolizumab as first or second line treatment.