High PD-L1/IDO-2 and PD-L2/IDO-1 Co-Expression Levels Are Associated with Worse Overall Survival in Resected Non-Small Cell Lung Cancer Patients

• Published in: Genes Vol. 12; no. 2; p. 273
• Main Authors: Ludovini, Vienna, Bianconi, Fortunato, Siggillino, Annamaria, Vannucci, Jacopo, Baglivo, Sara, Berti, Valeria, Tofanetti, Francesca Romana, Reda, Maria Sole, Bellezza, Guido, Mandarano, Martina, Belladonna, Maria Laura, Metro, Giulio, Chiari, Rita, Sidoni, Angelo, Puma, Francesco, Minotti, Vincenzo, Roila, Fausto
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 15.02.2021; MDPI
• Subjects: Antigens; Apoptosis; Chemotherapy; Dendritic cells; FDA approval; Gene expression; Lung cancer; Lymphocytes; Medical prognosis; Non-small cell lung carcinoma; Patients; PD-1 protein; PD-L1 protein; Polymerase chain reaction; Reverse transcription; Small cell lung carcinoma; Tumors; Italy; mRNA expression levels; prognostic markers; early-stage NSCLC; immune-related genes
• DOI: 10.3390/genes12020273
• ISSN: 2073-4425

Programmed death ligand 1 (PD-L1) expression is a predictive biomarker of the success of PD-1/PD-L1 inhibitor therapy for patients with advanced non-small cell lung cancer (NSCLC) but its role as a prognostic marker for early-stage resectable NSCLC remains unclear. We studied gene expression levels of immune-related genes PD-1, PD-L1, PD-L2, IDO-1, IDO-2 and INFγ in tumor tissue of surgically resected NSCLC and correlated the finding with clinicopathological features and patient outcomes. A total of 191 consecutive early-stage NSCLC patients who underwent curative pulmonary resection were studied. The mRNA expression levels of immune-related genes were evaluated by quantitative reverse transcription polymerase chain reaction (qRT-PCR) using RT Profiler PCR Arrays (Qiagen). PD-1, PD-L2 and IDO-2 gene expression levels were significantly higher in patients with squamous histology ( = 0.001, = 0.021 and < 0.001; respectively). PD-1, PD-L1 and IDO-2 gene expression levels were significantly higher in patients with higher stage ( = 0.005, = 0.048 and = 0.002, respectively). The univariate analysis for recurrence-free survival (RFS) and overall survival (OS) showed that patients with higher levels of three-genes (PD-L1/PD-L2/INFγ) (hazard ratio (HR)) 1.90 (95% confidence interval (CI), 1.13-3.21), = 0.015) were associated with a worse RFS, while patients with higher levels of both genes (PD-L1/IDO-2) or (PD-L2/IDO-1) were associated with a worse OS (HR 1.63 95% CI, 1.06-2.51, = 0.024; HR 1.54 95% CI, 1.02-2.33, = 0.04; respectively). The multivariate interaction model adjusted for histology and stage confirmed that higher levels of three genes (PD-L1/PD-L2/INFγ) were significantly associated with worse RFS (HR 1.98, = 0.031) and higher levels of both genes (PD-L1/IDO-2) and (PD-L2/IDO-1) with worse OS (HR 1.98, = 0.042, HR 1.92, = 0.022). PD-L1/IDO-2 and PD-L2/IDO-1 co-expression high levels are independent negative prognostic factors for survival in early NSCLC. These features may have important implications for future immune-checkpoint therapeutic approaches.