Integrating pleural PD-1+CD8+ T cell as a complement variable into LENT score to assess lung adenocarcinoma patients complicated with MPE

Abstract

Malignant pleural effusion (MPE), a common complication of advanced lung cancer, especially lung adenocarcinoma, denotes an inferior life expectancy. An improved understanding of pleural PD-1+CD8+T cells in lung adenocarcinoma and their relevance to prognosis would enable suitable clinical decisions. Here, we observed that PD-1+CD8+T cells were ubiquitously present in MPE caused by NSCLC. Interestingly, the abundance of pleural PD-1+CD8+T cells was affected by EGFR mutations, whereas it was hardly affected by tumor PD-L1 expression. Furthermore, a higher abundance of pleural PD-1+CD8+T cells was found in patients with a high-risk LENT score, which is a predictive factor for inferior prognosis. The LENT score and pleural PD-1+CD8+T cells were identified as independent variables associated with survival and introduced into a novel scoring system (Immuno-LENT score). The statistical efficacy and robustness of this model were rigorously validated using the bootstrap method for C-index calculation. Refinement by the inclusion of pleural PD-1+CD8+T cells in the LENT score improved its performance in predicting survival among lung cancer patients with MPE. Altogether, our data show that the Immuno-LENT score is more valuable and applicable for guiding optimal clinical management.