Prognostic Significance of Tp53 and Pd-L1 Depending on the Type of Adjuvant Therapy in Patients With Non-Small Cell Lung Cancer

Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality despite the widespread implementation of adjuvant chemotherapy and immunotherapy. The identification of molecular biomarkers capable of predicting treatment efficacy is critical for developing a personalized therapeutic approach. TP53, one of the most frequently mutated genes in NSCLC, may influence immunotherapy response through modulation of PD-L1 expression.Objective. To evaluate the prognostic significance of p53 status in surgically treated NSCLC patients, considering PD-L1 expression and type of adjuvant therapy.Material and methods. This retrospective single-center study included 42 patients with stage IA–IIIB NSCLC who received adjuvant platinum-based chemotherapy (n=27) or combined chemoimmunotherapy with atezolizumab (n=15). Immunohistochemical analysis was performed to assess p53 and PD-L1 protein expression in tumor tissues. Mutant p53 was defined as either negative or overexpressed staining. PD-L1 expression was considered positive when ≥1% of tumor cells were stained; <1% was regarded as negative. Statistical analysis was conducted using the χ² test, log-rank test, and Kaplan–Meier method in Stata V.19.5. A p-value <0.05 was considered statistically significant.Results. The mean age of patients in the chemoimmunotherapy group was 59.7 ± 5.18 years, while in the chemotherapy group it was 57.7 ± 9.86 years. All patients (100.0%) in the chemoimmunotherapy group demonstrated positive PD-L1 expression, whereas only 55.6% of patients in the chemotherapy group were PD-L1 positive (p = 0.003). A significant difference in progression-free survival (Log-rank p = 0.0293) was observed exclusively among PD-L1-positive patients receiving chemoimmunotherapy: those with mutant p53 had a median PFS of 93.8 months, compared to 9.1 months in patients with wild-type p53. Overall survival was higher in patients with mutant p53, although the difference did not reach statistical significance. No such differences were observed in PD-L1-negative patients or in those who did not receive immunotherapy.Conclusions. TP53 mutations are associated with improved progression-free survival in PD-L1-positive surgically treated NSCLC patients receiving adjuvant chemoimmunotherapy, supporting the prognostic value of p53 and the rationale for its routine evaluation.