Association between the expression status of programmed cell death ligand 1 and the efficacy of pan-cancer neoadjuvant immune checkpoint blockade.

Background: Immune checkpoint inhibitors (ICIs)-based neoadjuvant therapy has been regulatory approved in clinical practice since 2021. However, it is still difficult to determine which patients can benefit from it. Here, we conducted a meta-analysis to evaluate the predictive values of programmed cell death ligand 1 (PD-L1) in pan-cancer neoadjuvant immunotherapy. Methods: We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) to collect information regarding pathological complete response (pCR) and event-free survival (EFS) in patients with PD-L1-positive and PD-L1-negative tumors. Odd ratio (OR), hazard ratio (HR), and their 95% confidence intervals (CIs) were calculated. Results: Totally, 10353 patients with 6 tumor types in 23 RCTs were included in this study. Neoadjuvant immunotherapy was associated with increased pCRs in both patients with PD-L1-positive (OR, 3.22; 95% CI, 2.25-4.61; Conclusion: Both patients with PD-L1-positive and PD-L1-negative tumors can benefit from neoadjuvant immunotherapy. However, the magnitude of efficacy is greater in patients with PD-L1-positive tumors. Accordingly, rather than serving as an independent marker for patient selection, PD-L1 expression is more effectively applied as a prognostic biomarker.