The product of the PD-L1 expression and neutrophil-to-lymphocyte ratio as a predictor of postoperative recurrence in non-small-cell lung cancer

Abstract

Abstract While the PD-L1 expression and neutrophil-to-lymphocyte ratio (NLR) are prognostic biomarkers for lung cancer, few studies have considered their interaction. We hypothesized that the product of the PD-L1 expression (tumor proportion score) and NLR (PD-L1×NLR) might be a postoperative prognostic marker reflecting the immune microenvironment of lung cancer. We analyzed the association between PD-L1×NLR and the postoperative recurrence-free survival in 616 non-small-cell lung cancer patients using multivariable Cox proportional hazards models. In the analysis of PD-L1×NLR as a categorical variable, the group with PD-L1×NLR ≥ 25.8 had a significantly higher hazard ratio (HR) than the group with < 25.8 (HR 1.95, 95% confidence interval [CI] 1.33–2.85). The HR for PD-L1×NLR, considered a continuous variable, was 1.004 (95% CI 1.002–1.006). The risk of postoperative recurrence increased 1.004-fold for each unit increase in PD-L1×NLR, and a more than 2-fold increase in risk was observed for the values of ≥ 170. The PD-L1×NLR may be used in real-world clinical practice as a marker to predict the risk of recurrence after lung cancer surgery.