Background For non-small cell lung cancer (NSCLC) the most used method for analysing programmed cell death ligand 1 (PD-L1) expression is the Tumor Proportion Score (TPS). Nevertheless, for other tumour types, the Combined Positive Score (CPS) has been the method of choice.
Aim Evaluate and compare the predictive value of both CPS and TPS as predictors of immunotherapy response in NSCLC, and to evaluate the agreement intra-observer between both methods and inter-observer between two expert lung pathologists.
Methods 56 NSCLC patients who were treated with anti-programmed cell death 1 (PD-1)/PD-L1 therapy were included. Two pathologists evaluated all cases independently, considering the sample’s adequacy for analysis, and the PD-L1 expression by TPS and CPS.
Results The Kappa coefficient for adequacy was 0.82 (95% CI 0.67 to 0.97). There was a high agreement between TPS and CPS and a high agreement between pathologists concerning the two methods. The Kappa coefficient between TPS and CPS was 0.85 for both pathologists, and between pathologists was 0.94 and 0.93 for TPS and CPS, respectively.
Conclusions Both methods proved to be equally predictive of response to anti-PD-1/PD-L1 therapy. There was both a high intra-observer agreement between the two methods and a high inter-observer agreement between pathologists. This study suggests that CPS could also be used in a routine setting for immunotherapy decision in NSCLC.
- lung neoplasms
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Handling editor Dhirendra Govender.
Contributors PDM: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Data curation, Roles/Writing – original draft, Writing – review & editing, Visualization, Project administration. LFL: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Data curation, Writing – review & editing, Visualization, Project administration. VDdS: Investigation, Resources, Writing – review & editing, Visualization. ECAdS: Investigation, Resources, Writing – review & editing, Visualization. VCCdL: Methodology, Formal analysis, Writing – review & editing, Visualization, Supervision. RMR: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Data curation, Writing – review & editing, Visualization, Supervision, Funding acquisition.
Funding This study was funded by the Public Ministry of Labor Campinas (Research, Prevention and Education of Occupational Cancer) and by Barretos Cancer Hospital internal funds.
Competing interests LFL is recipient of a Public Ministry of Labor Campinas Fellowship, and RMR is recipient of CNPq productivity fellowship.
Patient consent for publication Not required.
Ethics approval The institutional review board approved the study protocol (CAAE 87212918.5.0000.5437) and a waiver for the written informed consent was obtained, given the retrospective nature of the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article.
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