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Crucially, nsPEF induces immunogenic cell death that stimulates systemic immunity against residual/metastatic disease (49), though it simultaneously elevates membrane PD-L1 levels and promotes PD-L1 + extracellular vesicle release, causing CD8 + T-cell dysfunctionan effect reversed by PD-L1 blockade to significantly suppress tumor growth and improve survival (50, 51)