基于 PD-L1 表达、肿瘤组织病理学和突变负荷（EGFR 和 KRAS）的晚期肺癌亚型分型：一项来自北印度的研究

Immune checkpoint inhibitor (PD-L1) therapy of advanced non-small-cell lung cancer (NSCLC) has variable outcomes. Tumor subtypes based on PD-L1 expression, histopathology, mutation burden is required for patient stratification and formulation of treatment guidelines. Lung cancers (n=57) diagnosed at Pathology department, VPCI (2018-2021) were retrospectively analyzed. PD-L1(SP263) expressed by tumor cells [low (<1%), medium (1-49%), high (≥50%)] was correlated with histopathology, microenvironment, EGFR, KRAS expression. Patients were categorized into high and low risk based on their: i) gender: males (n=47, 30-89 years), females (n=10, 45-80 years); ii) smoking history: males 26/47 (45. 61%), females 1/10 (10%); iii) tumor subtyping: squamous cell carcinoma 15/57 (26. 32%), adenocarcinoma 6/57 (17. 54%), NSCLC-undifferentiated 24/57 (42.

10%), adenosquamous carcinoma 5/57 (8. 77 %), carcinosarcoma 4/57 (7. 02%), small cell carcinoma 1/57 (1. 75%); iv) inflammatory tumor microenvironment/TILs 44/57 (77. 1%); iv) PD-L1 positivity-31/57 (54. 3%); v) concomitant EGFR/KRAS positivity. PD-L1positive cases showed squamous/undifferentiated histopathology, concomitant EGFR+ (9/20, 45%) and KRAS+ (8/15, 53. 3%), smoking+ (21/31,67. 74%). PD-L1 negative cases (26/57, 45.

6%), were EGFR+ (2/14, 14. 28%) and KRAS+ (6/19, 31. 5%). The high-risk lung cancer subtypes show squamous/undifferentiated histopathology, inflammatory microenvironment, male preponderance, smoking history, higher concomitant PD-L1, KRAS and EGFR positivity. Lung cancer subtyping can predict clinical response/resistance of patients prior to initiation of PD-L1 inhibitor therapies and can be used to guide therapy.