PD-L1 expression across molecular driver subsets in non-small cell lung carcinoma: a 299-case real-world thoracic oncology cohort.

Authors

Arzu Taşdemir, Hatice Karaman, Nihal Kiremit, Murat Levent Güneş, Ender Doğan, İbrahim Ethem Özsoy

Published in

BMC cancer. Volume 26. Issue 1. Jul 30, 2026. Epub Jul 30, 2026.

Abstract

PD-L1 immunohistochemistry and molecular driver testing are complementary components of non-small cell lung carcinoma (NSCLC) evaluation. We examined the distribution of PD-L1 tumor proportion score (TPS) across routinely detected molecular driver subsets in a consecutive real-world thoracic oncology cohort.
We retrospectively reviewed 299 consecutive NSCLC cases that underwent clinical targeted next-generation sequencing (NGS) between 2023 and 2025. Archived VENTANA SP263-stained PD-L1 slides were re-reviewed by two pathologists and categorized as TPS < 1%, 1-49%, or > = 50%. Driver-association analyses were restricted to PD-L1-tested tumors with an evaluable, mutually exclusive primary driver category; cases with indeterminate DNA-driver status were excluded. Prespecified KRAS and EGFR contrasts used reproducible 2 × 2 methods, with univariable Firth regression as a sparse-cell sensitivity analysis.
PD-L1 results were available for 237 tumors. TPS was < 1% in 63 cases (26.6%), 1-49% in 108 cases (45.6%), and > = 50% in 66 cases (27.8%). Among 223 PD-L1-tested tumors with an evaluable, mutually exclusive primary driver category, KRAS-mutant tumors were more frequently PD-L1 high than the other evaluable categories (24/54 [44.4%] vs. 35/169 [20.7%]; OR, 3.06; 95% CI, 1.59-5.89; p = 0.001). EGFR-mutant tumors showed a lower PD-L1-high frequency, but this observation was based on only two PD-L1-high events (2/26 [7.7%] vs. 57/197 [28.9%]; OR, 0.20; 95% CI, 0.05-0.89; p = 0.019). Eleven cases with indeterminate DNA-driver status were excluded from driver-frequency and association analyses.
PD-L1 high expression was enriched among KRAS-mutant NSCLC in this diagnostic cohort, whereas EGFR-mutant tumors showed a directionally lower but sparse-data-limited PD-L1-high pattern. These findings support integrated interpretation of PD-L1 and molecular driver results in routine practice, but they should be viewed as biomarker-distribution evidence rather than proof of immunotherapy benefit or prognosis.

PMID:
42963764
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.

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