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

## TL;DR

This study improves a lung cancer prognosis tool by adding a new immune cell measure, helping doctors better predict outcomes for patients with fluid buildup in the lungs.

## Contribution

Introduces the Immuno-LENT score, combining PD-1+CD8+ T cell abundance with the LENT score for improved prognosis in lung cancer with MPE.

## Key findings

- PD-1+CD8+ T cells were present in all pleural fluid samples from MPE patients.
- EGFR mutations influenced PD-1+CD8+ T cell abundance, but PD-L1 expression did not.
- The Immuno-LENT score was a robust, independent prognostic factor with high predictive accuracy.

## Abstract

Malignant pleural effusion (MPE) is a common complication of advanced non-small cell lung cancer (NSCLC), particularly in lung adenocarcinoma, and is associated with poor prognosis. A better understanding of the role of PD-1+CD8+ T cells in the pleural environment and their relevance to patient survival could facilitate better clinical decision-making.

We performed a cohort study involving NSCLC patients with MPE. The abundance of pleural PD-1+CD8+ T cells was measured using flow cytometry. We also assessed the presence of epidermal growth factor receptor (EGFR) mutations and programmed death-ligand 1 (PD-L1) expression in the pleural fluid. The LENT score, a known prognostic tool, was combined with pleural PD-1+CD8+ T cell abundance to develop a novel scoring system, the Immuno-LENT score. The model’s performance was validated using the bootstrap method and concordance index (C-index) calculation.

We found that PD-1+CD8+ T cells were present in the pleural fluid of all patients with MPE. Notably, the abundance of these cells was influenced by EGFR mutations, while PD-L1 expression had little effect. Patients with a higher abundance of pleural PD-1+CD8+ T cells also exhibited higher LENT scores, correlating with poorer survival. The Immuno-LENT score, incorporating both the LENT score and pleural PD-1+CD8+ T cell abundance, was found to be an independent prognostic factor. The model showed strong statistical robustness with a high C-index.

The combination of pleural PD-1+CD8+ T cells with the LENT score offers a more accurate prognostic tool for survival prediction in NSCLC patients with MPE. Our findings suggest that the Immuno-LENT score could guide clinical management and inform therapeutic decisions for these patients, improving patient outcomes by tailoring interventions based on a more comprehensive biomarker profile.