Computed Tomography Features of Lung Adenocarcinomas With Programmed Death Ligand 1 Expression

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Abstract

Introduction

The development of immune checkpoint inhibitors against programmed death 1 has paved the way for a new era of treatment of lung cancer. Programmed death-ligand 1 (PD-L1) is expected to predict the response of immune checkpoint inhibitors in lung cancer. Predicting PD-L1 expression using a noninvasive method before immunotherapy would, therefore, help identify patients for whom immunotherapy can be successful.

Patients and Methods

A total of 394 patients with resected lung adenocarcinoma who had undergone preoperative thin-section computed tomography (CT) were analyzed for PD-L1 expression by immunohistochemistry and evaluated to determine the association between PD-L1 expression and CT characteristics, including convergence, surrounding ground glass opacity (GGO), air bronchogram, notching, pleural indentation, spiculation, and cavitation.

Results

Of the 394 patients, 78 (19.8%) were positive and 316 (80.2%) were negative for PD-L1 expression. Univariate analysis demonstrated that PD-L1+ adenocarcinoma was significantly associated with the presence of convergence (P < .01), notching (P < .01), spiculation (P < .01), and cavitation (P < .01) and the absence of surrounding GGO (P < .01) compared with PD-L1− cases. On multivariate analysis, the presence of convergence (P < .01) and cavitation (P < .01) and the absence of surrounding GGO (P = .02) and air bronchogram (P = .03) were significantly associated with PD-L1 expression.

Conclusion

PD-L1+ adenocarcinoma cases showed convergence and cavitation more frequently than did PD-L1− cases. In contrast, surrounding GGO and air bronchogram were observed less frequently in PD-L1+ cases than in PD-L1− cases. These results will prove helpful in identifying PD-L1–expressing adenocarcinoma by CT before immunotherapy.

Micro-Abstract

Our objective was to clarify the computed tomography features of programmed death-ligand 1 (PD-L1)–expressing lung adenocarcinomas. Among 394 patients, 78 (19.8%) were positive for PD-L1 expression. On multivariate analysis, the presence of convergence (P < .01) and cavitation (P < .01) and the absence of surrounding ground glass opacity (P = .02) and air bronchogram (P = .03) were shown to be significantly associated with PD-L1 expression.

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