PD-L1 gene polymorphism and high level of plasma soluble PD-L1 protein may be associated with non-small cell lung cancer



PD-1 and its ligand PD-L1 belong to the co-inhibition molecules, which can downregulate immune responses. The PD-L1 polymorphism and the level of soluble PD-L1 (sPD-L1) were investigated in non-small cell lung cancer (NSCLC).


A total of 288 NSCLC patients and 300 controls were enrolled. An A/C polymorphism at position 8923 in the PD-L1 gene was genotyped using the polymerase chain reaction-restriction fragment length polymorphism method.


The prevalence of the 8923C allele was significantly higher in NSCLC patients than controls (10.2% versus 5.3%, p = 0.002, odds ratio 2.03, 95% confidence interval 1.30-3.17; data were adjusted for age and sex). NSCLC patients also showed increased plasma levels of sPD-L1 compared to controls (1.92 ng/mL versus 0.91 ng/mL, p<0.001). Furthermore, lung adenocarcinoma patients had higher sPD-L1 levels than patients with squamous cell carcinoma (p<0.01). However, no association was observed between the different genetic variants and plasma concentrations of sPD-L1.


The PD-L1 8923A/C polymorphism could be associated with increased susceptibility to NSCLC. Plasma levels of sPD-L1 are significantly increased in NSCLC patients, especially those with adenocarcinoma.

Int J Biol Markers 2015; 30(4): e364 - e368




Sensen Cheng, Jinsong Zheng, Jingyan Zhu, Chao Xie, Xia Zhang, Xiao Han, Bao Song, Yuan Ma, Jie Liu

Article History


Financial support: None.
Conflict of interest: The authors declare no competing interests.

This article is available as full text PDF.

Download any of the following attachments:


Lung cancer is a malignant cancer with high morbidity and mortality rates worldwide (1). The disease is caused by many genetic and environmental factors such as tobacco smoking, infectious agents and radiation. In the last 2 decades, there have been an increasing number of studies focusing on the hereditary component of this disease. However, the specific mechanism is still unclear. Genome-wide linkage scans and genome-wide association studies (GWAS) make great efforts to offer sufficient power to seek disease-causing genetic factors (2).

Programmed death ligand 1 (PD-L1) is the third member of the B7 superfamily (3). Accumulating evidence has suggested that PD-L1 is involved in the negative regulation of the immune response. PD-L1 is expressed in T and B cells, macrophages and dendritic cells (4). It is also expressed in NSCLC cells (5). PD-1/PD-L1 interaction can downregulate T-cell responses and is an important pathway by which cancer cells evade the host immune surveillance (6, 7). PD-L1 has 2 forms of expression, a membrane-bound form and a soluble form. These 2 forms also have been found in other members of the B7/CD28 family such as CTLA-4 (8), CD28 (9) and B7-H4 (10). Some studies have shown that the abnormal expression of soluble PD-L1 (sPD-L1) can affect immune responses, which may result in autoimmune diseases and tumors (11-12-13).

Several single nucleotide polymorphisms (SNPs) in the PD-L1 gene have been observed in the Asian population (, where the 8923A/C polymorphism has been widely reported. The SNP can be detected in the Chinese population and is associated with autoimmune Addison’s disease (14), type 1 diabetes (12), ankylosing spondylitis (15) and large B-cell lymphoma (16). However, reports about the SNP in lung cancer are rare. In this study, we investigated whether there is a correlation between the PD-L1 8923A>C SNP and NSCLC. Moreover, we investigated the effect of this polymorphism on sPD-L1 expression.

Materials and methods

Study population

Between January 2011 and December 2014, a total of 288 patients (190 men and 98 women) with NSCLC who registered at Shandong Cancer Hospital were recruited. All patients were newly diagnosed and diagnoses were confirmed by histopathological examination. Peripheral blood from patients was collected prior to systemic therapy. The median age of the patients was 42 years (range: 26-78). The control group was made up of 300 volunteers who visited the same hospital during the same period. We only allowed Han Chinese into the group to exclude possible effects of ethnicity. Randomly selected controls were matched to the cases by age (±5 years) and gender. Informed consent was obtained from each participant at the time of recruitment. The study was approved by the review board of Shandong Cancer Hospital. Peripheral blood was collected from each study participant.


Genomic DNA was extracted from peripheral blood leukocytes using the AxyPrep Blood Genomic DNA Miniprep Kit (Fastagen, Shanghai, China) according to the manufacturer’s instructions. The primers to amplify a 553-bp PCR product for rs74589371 (position 8923) were 5’-AATGGCTTGTTGTCCAGAGATG-3’ and 5’-GTACCACATGGAGT- GGCTGC-3’. PCR products were digested with Eco91I (New England Biolabs, Ipswich, MA, USA) and separated on 3% polyacrylamide gels. The presence of the A allele allowed the digestion of the 553-bp amplicon into 2 products of 456 bp and 97 bp, and the C allele resulted in 326 bp, 130 bp and 97 bp. About 10% of the PCR products were examined by DNA sequencing to confirm the genotyping results. Results between polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing analysis were 100% concordant.

Assessment of sPD-L1 level

Levels of sPD-L1 were tested using an enzyme-linked immunosorbent assay (ELISA) kit (PDCD1LG1 ELISA kit, USCN Life Science, Wuhan, China) according to the manufacturer’s instructions. Each sample was analyzed in duplicate. The intra- and interassay coefficients of variation were <9%.

Statistical analyses

The SPSS statistical software package version 19.0 was used for all statistical analyses. The genotype and allele frequencies of the PD-L1 polymorphism were compared using the chi-square test. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to assess the relative risks. Demographic and clinical data between groups were compared by the chi-square test and Student’s t-test. Plasma levels of sPD-L1 were compared by Student’s t-test. P<0.05 was considered statistically significant.


Clinical characteristics of the study participants

The clinical characteristics of the participants are presented in Table I. No significant differences in age or gender were observed between cases and controls. However, there was a significantly higher percentage of smokers in the patient group compared with the control group (61.8% vs. 46.3%, p<0.001).

Characteristics of NSCLC patients and controls

Characteristic Cases (n = 288) Controls (n = 300) OR (95% CI) P value
OR = odds ratio; CI = confidence interval.
Age, years
 Mean 42.0 ± 15.0 44.5 ± 14.9 0.624
 Male 190 193 1
 Female 98 107 0.93 (0.66-1.31) 0.677
Smoking status
 Nonsmokers 110 (38.2%) 161 (53.7%) 1
 Smokers 178 (61.8%) 139 (46.3%) 1.87 (1.35-2.60) <0.001
Histological cell type
 Adenocarcinoma 153 (53.1%)
 Squamous cell carcinoma 100 (34.7%)
 Others 35 (12.2%)
Tumor stage
 I 43 (14.9%)
 II 49 (17.0%)
 III 86 (29.9%)
 IV 110 (38.2%)

Association between PD-L1 gene polymorphism and NSCLC susceptibility

The genotype and allele frequencies of the PD-L1 8923A>C polymorphism in NSCLC and control groups are summarized in Table II. The frequencies of AA, AC and CC genotypes were 80.9%, 17.7% and 1.4%, respectively, among NSCLC patients, and 89.7%, 10.0% and 0.3% among controls. The C-allele frequency was significantly higher in NSCLC patients than controls (10.2% vs. 5.3%, p = 0.002, OR = 2.03, 95% CI 1.30-3.17; data were adjusted for age and sex). In addition, we investigated the association between the PD-L1 gene polymorphism and smoking status in NSCLC patients. The results showed that the distribution of the SNP was similar between patients with different smoking status (data not shown).

Distribution of PD-L1 A>C polymorphism at position 8923 in NSCLC patients and healthy controls

Polymorphism Cases, n (%) Controls, n (%) OR (95% CI) P value
OR = odds ratio; CI = confidence interval.
 A/A 233 (80.9) 269 (89.7) 1
 A/C 51 (17.7) 30 (10) 1.96 (1.21-3.18) 0.006
 C/C 4 (1.4) 1 (0.3) 4.62 (0.51-41.61) 0.173
 A 517 (89.8) 568 (94.7) 1
 C 59 (10.2) 32 (5.3) 2.03 (1.30-3.17) 0.002

Plasma level of sPD-L1 and NSCLC

We investigated the plasma levels of sPD-L1 in NSCLC patients and controls, and found that patients had higher levels (1.92 ng/mL vs. 0.91 ng/mL, p<0.001) (Fig. 1). Furthermore, patients with adenocarcinoma had higher sPD-L1 levels than those with squamous cell carcinoma (p<0.01) (Fig. 2A). Similarly, patients with advanced clinical stages of disease (III-IV) had higher levels than those at early stages (I-II) (Fig. 2B), suggesting that sPD-L1 may be correlated with the progression of NSCLC. However, gender and smoking seemed not to affect the sPD-L1 level in NSCLC patients (Figs. 2C, 2D).

Plasma levels of sPD-L1 in NSCLC patients and controls.

(A) Plasma levels of sPD-L1 in NSCLC patients with different histological types. AD = adenocarcinoma; SCC = squamous cell carcinoma; NS = not significant. (B) Plasma levels of sPD-L1 in NSCLC patients with different clinical stages. (C) Plasma levels of sPD-L1 in NSCLC patients of different genders. (D) Plasma levels of sPD-L1 in NSCLC patients with different smoking status.

Effect of PD-L1 gene polymorphism on sPD-L1 level

We further evaluated whether the PD-L1 gene polymorphism could affect sPD-L1 levels. The results revealed that the levels of sPD-L1 were similar between AA genotype and C allele carriers (Fig. 3).

(A) Plasma levels of sPD-L1 between AA genotype and C allele in NSCLC patients. (B) Plasma levels of sPD-L1 between AA genotype and C allele in healthy controls.


It has been reported that the PD-L1 8923A>C SNP is associated with different diseases. However, knowledge about the relation of this SNP to NSCLC remains limited. In this study, we found that the 8923C allele was associated with an increased risk of NSCLC in a Chinese population.

The PD-L1 gene has been mapped to chromosome 9p24 spanning 17.9 kb and including 7 exons. The gene is highly conserved. The A/C polymorphism at position 8923 in the PD-L1 gene occurs in intron 4. This locus has been reported to be associated with Graves’ disease (17) and lung cancer (18). Our results are consistent with the previous report (18). However, the function of the 8923 polymorphism is not clear. Hayashi et al (17) found that the polymorphism is near or within transcriptional factor binding sites, which may affect the processing and the binding affinity of transcriptional factors. Thus, the SNP may result in the production of a protein that lacks functional domains.

PD-L1 exists in humans in a membranous form and a soluble form that contributes to a precise immune regulation network (19, 20). Although no studies have confirmed that sPD-L1 is a direct inhibitory signal of PD-1-positive T cells, sPD-L1 can inhibit neighboring cells by participating in blood circulation and combining the surface receptors of distant cells, which may contribute to the occurrence and development of malignant diseases (21, 22). sPD-L1 has been found in a variety of diseases such as rheumatoid arthritis (11), renal cell carcinoma (23) and type 2 diabetes mellitus (24). Our data showed elevated levels of sPD-L1 in NSCLC patients, especially those with adenocarcinoma, suggesting that sPD-L1 secretion may have cell specificity (Fig. 1, Fig. 2A). In addition, we observed a positive association between sPD-L1 levels and stages of NSCLC (Fig. 2B), which suggests a potential effect of sPD-L1 on tumor progression.

We investigated whether the 8923A/C polymorphism could affect sPD-L1 expression. However, we did not observe any differences between subjects with different genotypes (Figs. 3A, 3B), which indicates that the SNP may not affect the promoter activity of the PD-L1 gene. Further experiments are needed to explore whether this polymorphism could affect the expression of membranous PD-L1.

There are some limitations to our study. First of all, only 1 SNP was investigated, which may produce marginal effects. In addition, since an SNP study or GWAS is based on the common disease-common variant (CD-CV) hypothesis, it may generate a lot of potential bias. By examining 288 NSCLC patients and 300 controls, we found that the prevalence of the 8923C allele was significantly increased in NSCLC patients. However, it might be premature to conclude there is an association between the 8923A/C SNP and the risk of NSCLC. Further studies with a larger sample size and different study population would be necessary. Also, it would be interesting to conduct prospective studies to confirm these findings.

In summary, our results suggest that the PD-L1 8923A/C polymorphism may be associated with an increased risk of NSCLC. Furthermore, an elevated plasma level of sPD-L1 was observed in NSCLC patients. This research sheds some light on the pathogenesis of NSCLC.


Financial support: None.
Conflict of interest: The authors declare no competing interests.
  • 1. Jemal A Bray F Center MM Ferlay J Ward E Forman D Global cancer statistics. CA Cancer J Clin 2011 61 2 69 90 Google Scholar
  • 2. Chen W Zhang S Zou X Evaluation on the incidence, mortality and tendency of lung cancer in China. Thorac Cancer 2010 1 1 35 40 Google Scholar
  • 3. Dong H Zhu G Tamada K Chen L B7-H1, a third member of the B7 family, co-stimulates T-cell proliferation and interleukin-10 secretion. Nat Med 1999 5 12 1365 1369 Google Scholar
  • 4. Latchman Y Wood CR Chernova T et al. PD-L2 is a second ligand for PD-1 and inhibits T cell activation. Nat Immunol 2001 2 3 261 268 Google Scholar
  • 5. D’Incecco A Andreozzi M Ludovini V et al. PD-1 and PD-L1 expression in molecularly selected non-small-cell lung cancer patients. Br J Cancer 2015 112 1 95 102 Google Scholar
  • 6. Sznol M Chen L Antagonist antibodies to PD-1 and B7-H1 (PD-L1) in the treatment of advanced human cancer. Clin Cancer Res 2013 19 5 1021 1034 Google Scholar
  • 7. Quezada SA Peggs KS Exploiting CTLA-4, PD-1 and PD-L1 to reactivate the host immune response against cancer. Br J Cancer 2013 108 8 1560 1565 Google Scholar
  • 8. Oaks MK Hallett KM Cutting edge: a soluble form of CTLA-4 in patients with autoimmune thyroid disease. J Immunol 2000 164 10 5015 5018 Google Scholar
  • 9. Sakthivel P Shively V Kakoulidou M Pearce W Lefvert AK The soluble forms of CD28, CD86 and CTLA-4 constitute possible immunological markers in patients with abdominal aortic aneurysm. J Intern Med 2007 261 4 399 407 Google Scholar
  • 10. Kamimura Y Kobori H Piao J et al. Possible involvement of soluble B7-H4 in T cell-mediated inflammatory immune responses. Biochem Biophys Res Commun 2009 389 2 349 353 Google Scholar
  • 11. Wan B Nie H Liu A et al. Aberrant regulation of synovial T cell activation by soluble costimulatory molecules in rheumatoid arthritis. J Immunol 2006 177 12 8844 8850 Google Scholar
  • 12. Pizarro C García-Díaz DF Codner E Salas-Pérez F Carrasco E Pérez-Bravo F PD-L1 gene polymorphisms and low serum level of PD-L1 protein are associated to type 1 diabetes in Chile. Diabetes Metab Res Rev 2014 30 8 761 766 Google Scholar
  • 13. Velcheti V Schalper KA Carvajal DE et al. Programmed death ligand-1 expression in non-small cell lung cancer. Lab Invest 2014 94 1 107 116 Google Scholar
  • 14. Mitchell AL Cordell HJ Soemedi R et al. Programmed death ligand 1 (PD-L1) gene variants contribute to autoimmune Addison’s disease and Graves’ disease susceptibility. Clin Endocrinol Metab 2009 94 12 5139 5145 Google Scholar
  • 15. Yang Q Liu Y Liu D Zhang Y Mu K Association of polymorphisms in the programmed cell death 1 (PD-1) and PD-1 ligand genes with ankylosing spondylitis in a Chinese population. Clin Exp Rheumatol 2011 29 1 13 18 Google Scholar
  • 16. Twa DD Chan FC Ben-Neriah S et al. Genomic rearrangements involving programmed death ligands are recurrent in primary mediastinal large B-cell lymphoma. Blood 2014 123 13 2062 2065 Google Scholar
  • 17. Hayashi M Kouki T Takasu N Sunagawa S Komiya I Association of an A/C single nucleotide polymorphism in programmed cell death-ligand 1 gene with Graves’ disease in Japanese patients. Eur J Endocrinol 2008 158 6 817 822 Google Scholar
  • 18. Chen YB Mu CY Chen C Huang JA Association between single nucleotide polymorphism of PD-L1 gene and non-small cell lung cancer susceptibility in a Chinese population. Asia Pac J Clin Oncol 2014 10 2 e1 e6 Google Scholar
  • 19. Jung HW Choi SW Choi JI Kwon BS Serum concentrations of soluble 4-1BB and 4-1BB ligand correlated with the disease severity in rheumatoid arthritis. Exp Mol Med 2004 36 1 13 22 Google Scholar
  • 20. Jeannin P Magistrelli G Aubry JP et al. Soluble CD86 is a costimulatory molecule for human T lymphocytes. Immunity 2000 13 3 303 312 Google Scholar
  • 21. Butte MJ Peña-Cruz V Kim MJ Freeman GJ Sharpe AH Interaction of human PD-L1 and B7-1. Mol Immunol 2008 45 13 3567 3572 Google Scholar
  • 22. Butte MJ Keir ME Phamduy TB Sharpe AH Freeman GJ Programmed death-1 ligand 1 interacts specifically with the B7-1 costimulatory molecule to inhibit T cell responses. Immunity 2007 27 1 111 122 Google Scholar
  • 23. Frigola X Inman BA Lohse CM et al. Identification of a soluble form of B7-H1 that retains immunosuppressive activity and is associated with aggressive renal cell carcinoma. Clin Cancer Res 2011 17 7 1915 1923 Google Scholar
  • 24. Shi B Du X Wang Q Chen Y Zhang X Increased PD-1 on CD4(+)CD28(-) T cell and soluble PD-1 ligand-1 in patients with T2DM: association with atherosclerotic macrovascular diseases. Metabolism 2013 62 6 778 785 Google Scholar



  • School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences, Jinan, Shandong - China
  • Department of Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong - China
  • Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong - China
  • Sensen Cheng, Jinsong Zheng and Jingyan Zhu contributed equally to this work

Article usage statistics

The blue line displays unique views in the time frame indicated.
The yellow line displays unique downloads.
Views and downloads are counted only once per session.

No supplementary material is available for this article.