The critical role of PD-L1 expression in immunotherapy for advanced non-small cell lung cancer
Letter to the Editor

The critical role of PD-L1 expression in immunotherapy for advanced non-small cell lung cancer

Yi Deng1#, Yongyu Li2#, Rongde Xu3, Jing Li1,4, Wei Cui3

1Medical School, Kunming University of Science and Technology, Department of Pulmonary and Critical Care Medicine, The First People’s Hospital of Yunnan Province, Kunming, China; 2Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; 3Department of Interventional Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; 4Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China

#These authors contributed equally to this work.

Correspondence to: Wei Cui, MD. Department of Interventional Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2nd Road, Guangzhou 510080, China. Email: cuiwei@gdph.org.cn; Jing Li, MD. Medical School, Kunming University of Science and Technology, Department of Pulmonary and Critical Care Medicine, The First People’s Hospital of Yunnan Province, Kunming 650500, China; Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China. Email: lijing2024@139.com.

Comment on: Xu S, Bie ZX, Li YM, Qi J, Peng JZ, Li XG. Maintenance treatment of immunotherapy after microwave ablation plus drug-eluting bead bronchial arterial chemoembolization for advanced non-small cell lung cancer: a retrospective single-center cohort study. Quant Imaging Med Surg 2024;14:3473-88.

Submitted Jan 26, 2025. Accepted for publication Mar 07, 2025. Published online Apr 08, 2025.

doi: 10.21037/qims-2025-209

Recently, we were highly intrigued by the study published in this journal by Xu et al. (1), which examines the maintenance immunotherapy following microwave ablation (MWA) combined with drug-eluting bead bronchial arterial chemoembolization (DEB-BACE) in patients with advanced non-small cell lung cancer (NSCLC). We are extremely grateful for the valuable insights offered by the authors. Although this study offers significant reference points for future clinical practice, it is important to acknowledge several limitations that, if resolved, could strengthen the reliability and validity of the findings.

First, the article is deficient in data on the baseline expression levels of programmed cell death-ligand 1 (PD-L1) among the patients. Although the authors noted that patients in Group A had high PD-L1 expression, specific details regarding PD-L1 expression should be provided. Furthermore, a prospective study indicated that in the immunochemotherapy group, The pathological complete remission (pCR) rates varied with PD-L1 expression levels: 9.0% for <1%, 16.3% for 1–49%, and 27.5% for ≥50% (2). There was a positive correlation between the short-term efficacy of immunochemotherapy and PD-L1 expression. Besides, in studies of perioperative immunotherapy, the decrease in the likelihood of disease progression, recurrence, and demise in the immunotherapy group with PD-L1 positivity (PD-L1 expression ≥1%) was greater than that in the negative group (PD-L1 expression <1%), suggesting that it could be used as a biomarker to predict the short-term efficacy and survival benefit of perioperative immunotherapy in resectable NSCLC (2-4).

Additionally, in observational trials, what matters more than the P value is the size of differences between groups, or the expert opinion on the importance of a predictor (5). Moreover, in Tab. 1 (1), the numbers of patients in Groups A, B, and C under the indications for interventional therapy—resistance to standard treatments—were incorrect, and the P value needs revision.

To summarize, this study offers valuable perspectives on the maintenance immunotherapy following MWA combined with DEB-BACE in the treatment of advanced NSCLC. Nevertheless, tackling the previously mentioned challenges in subsequent research endeavors could strengthen the study’s findings and provide a more effective direction for clinical applications.

Appendix 1: Response to “The critical role of PD-L1 expression in immunotherapy for advanced non-small cell lung cancer”

Acknowledgments

None.

Footnote

Funding: This study was supported by the National Key Research and Development Program of China (No. 2023YFC2507104).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-2025-209/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Xu S, Bie ZX, Li YM, Qi J, Peng JZ, Li XG. Maintenance treatment of immunotherapy after microwave ablation plus drug-eluting bead bronchial arterial chemoembolization for advanced non-small cell lung cancer: a retrospective single-center cohort study. Quant Imaging Med Surg 2024;14:3473-88. [Crossref] [PubMed]
  2. Heymach JV, Harpole D, Mitsudomi T, Taube JM, Galffy G, Hochmair M, et al. Perioperative Durvalumab for Resectable Non-Small-Cell Lung Cancer. N Engl J Med 2023;389:1672-84. [Crossref] [PubMed]
  3. Forde PM, Spicer J, Lu S, Provencio M, Mitsudomi T, Awad MM, et al. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med 2022;386:1973-85. [Crossref] [PubMed]
  4. Lu S, Zhang W, Wu L, Wang W, Zhang P. Perioperative Toripalimab Plus Chemotherapy for Patients With Resectable Non-Small Cell Lung Cancer: The Neotorch Randomized Clinical Trial. JAMA 2024;331:201-11. Erratum in: JAMA 2025;333:910. [Crossref] [PubMed]
  5. Flom P, Harron K, Ballesteros J, Kalinda C, Koutoumanou E, Miles J, Nevitt SJ, Rohloff P. Common errors in statistics and methods. BMJ Paediatr Open 2024;8:e002755. [Crossref] [PubMed]
Cite this article as: Deng Y, Li Y, Xu R, Li J, Cui W. The critical role of PD-L1 expression in immunotherapy for advanced non-small cell lung cancer. Quant Imaging Med Surg 2025;15(5):4894-4895. doi: 10.21037/qims-2025-209

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