本大规模、多中心、回顾性观察性研究旨在评估亚厘米级肺结节中，前癌病变和浸润性腺癌与程序化死亡配体-1（PD-L1）表达相关的临床病理学和分子特征。纳入了经组织学确诊的非典型腺瘤样增生（AAH）、原位腺癌（AIS）、微创性腺癌（MIA）和浸润性腺癌（ADC）患者。使用PD-L1免疫组织化学22C3 PharmDx试剂盒（Agilent，美国加利福尼亚圣克拉拉）在每个中心评估PD-L1表达。肿瘤比例评分（TPS）的截断值设定为≥ 1％和≥ 50％。分析了来自1844名患者的2022个结节。其中，9个（0.45％）结节的PD-L1 TPS ≥ 50％，187个（9.25％）结节的PD-L1 TPS为1-49％，1826个（90.30％）结节的PD-L1 TPS＜1％。总共378个（18.69％）、1016个（50.25％）和628个（31.06％）结节根据病理学诊断为AAH/AIS、MIA和ADC。根据计算机断层扫描，共有1377个（68.10％）、591个（25.67％）和54个（2.67％）结节被诊断为纯磨玻璃样浸润（GGO）、混合GGO和实性结节。PD-L1表达与异型淋巴瘤激酶（ALK）突变状态之间存在显著差异（P < 0.001）。PD-L1表达水平与国际肺癌研究协会（IASLC）分级系统所测得的PD-L1表达水平显著不同（P < 0.001）。PD-L1表达与亚厘米级肺结节的影像学和病理学侵袭性以及驱动基因突变状态显著相关。PD-L1表达在早期肺腺癌进化中的意义还需要进一步研究。©2023年。外科肿瘤学会发表。

This large-scale, multicenter, retrospective observational study aimed to evaluate the clinicopathological and molecular profiles associated with programmed death-ligand 1 (PD-L1) expression in precancerous lesions and invasive adenocarcinoma in subcentimeter pulmonary nodules.Patients with histologically confirmed atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (ADC) were included. PD-L1 expression was evaluated at each center using a PD-L1 immunohistochemistry 22C3 pharmDx kit (Agilent, Santa Clara, CA, USA). The tumor proportion score (TPS) cutoff values were set at ≥ 1% and ≥ 50%.A total of 2022 nodules from 1844 patients were analyzed. Of these, 9 (0.45%) nodules had PD-L1 TPS ≥ 50%, 187 (9.25%) had PD-L1 TPS 1-49%, and 1826 (90.30%) had PD-L1 TPS < 1%. A total of 378 (18.69%), 1016 (50.25%), and 628 (31.06%) nodules were diagnosed as AAH/AIS, MIA, and ADC, respectively, by pathology. A total of 1377 (68.10%), 591 (25.67%), and 54 (2.67%) nodules were diagnosed as pure ground-glass opacity (GGO), mixed GGO, and solid nodules, respectively, by computed tomography. There was a significant difference between PD-L1 expression and anaplastic lymphoma kinase (ALK) mutation status (P < 0.001). PD-L1 expression levels were significantly different from those determined using the International Association for the Study of Lung Cancer (IASLC) grading system (P < 0.001).PD-L1 expression was significantly associated with radiological and pathological invasiveness and driver mutation status in subcentimeter pulmonary nodules. The significance of PD-L1 expression in the evolution of early-stage lung adenocarcinoma requires further investigation.© 2023. Society of Surgical Oncology.