Real-world data based on PD-L1 expression in early-stage NSCLC in an east-Asian patient population: A 10-year follow-up study.

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8019 Background: Recent studies on the perioperative treatment of Non-Small Cell Lung Cancer (NSCLC) have often excluded patients with stage IA. To address this issue and bridge the knowledge gap, we aim to investigate the impact of PD-L1 and EGFR status on survival in stage IA NSCLC. Methods: Our study aimed to determine the impact of PD-L1 expression on overall survival (OS) in patients with resectable stage IA-IIIB NSCLC who underwent curative resection between May 2010 and April 2020. We analyzed survival and clinicopathological data and categorized patients based on PD-L1 tumor proportion score (TPS). PD-L1 TPS ≥ 50% were categorized as PD-L1 high and < 50% as PD-L1 negative/low. Our primary objective was to assess the association between PD-L1 expression status and OS in resectable NSCLC patients. We also investigated the relationships between OS, PD-L1 expression, EGFR status, and tumor stage. Results: Among the 386 patients recruited, those with PD-L1 negative/low and high had a 5-year OS of 82% and 63%, respectively ( p = 0.00011). Among patients with stage IA NSCLC, those with PD-L1 negative/low demonstrated the most favorable 5-year OS (96%) compared to the other subgroups (stage IA PD-L1 high 63%, stage IB-IIIB PD-L1 negative/low 67% and stage IB-IIIB PD-L1 high 62%, p < 0.0001). Stage IA EGFR mutant NSCLC showed a significantly better 5-year OS compared to EGFR wildtype (97% versus 84%, p= 0.0028). In comparison, survival in stage IB-IIIB NSCLC was similar regardless of EGFR status (stage IB-IIIB/EGFR mutant 66% vs EGFR wildtype 65%, p= 0.13). Next, we addressed the impact of the co-occurrence of an EGFR mutation and PD-L1 expression on survival in stage IA. In stage IA, the PD-L1 high EGFR mutant and wildtype subgroups demonstrated a 5-year OS of 83% and 56%, respectively, while in the PD-L1 negative/low subgroup, the EGFR mutant and wildtype had a 98% and 93% OS ( p< 0.0001), respectively. Conclusions: Stage IA NSCLC patients with PD-L1 high and EGFR wildtype, surprisingly, were associated with poorer survival outcomes. These findings highlight the urgent need for clinical trials investigating perioperative management strategies in this population.