Prognostic significance of volume-based 18F-FDG PET/CT parameters and correlation with PD-L1 expression in patients with surgically resected lung adenocarcinoma.

The aim of this study was to retrospectively analyze 18F-FDG positron emission tomography/computed tomography (18F-FDG PET/CT) metabolic variables, programmed death-ligand 1 (PD-L1) and phosphorylated signal transducer and activator of transcription 3 (p-STAT3) tumor expression, and other factors as predictors of disease-free survival (DFS) in patients with lung adenocarcinoma (LUAD) (stage IA-IIIA) who underwent surgical resection. We still lack predictor of immune checkpoint (programmed cell death-1 [PD-1]/PD-L1) inhibitors. Herein, we investigated the correlation between metabolic parameters from 18F-FDG PET/CT and PD-L1 expression in patients with surgically resected LUAD.Seventy-four patients who underwent 18F-FDG PET/CT prior to treatment were consecutively enrolled. The main 18F-FDG PET/CT-derived variables were primary tumor maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Surgical tumor specimens were analyzed for PD-L1 and p-STAT3 expression using immunohistochemistry. Correlations between immunohistochemistry results and 18F-FDG PET/CT-derived variables were compared. Associations of PD-L1 and p-STAT3 tumor expression, 18F-FDG PET/CT-derived variables, and other factors with DFS in resected LUAD were evaluated.All tumors were FDG-avid. The cutoff values of low and high SUVmax, MTV, and TLG were 12.60, 14.87, and 90.85, respectively. The results indicated that TNM stage, PD-L1 positivity, and high 18F-FDG PET/CT metabolic volume parameters (TLG ≥90.85 or MTV ≥14.87) were independent predictors of worse DFS in resected LUAD. No 18F-FDG metabolic parameters associated with PD-L1 expression were observed (chi-square test), but we found that patients with positive PD-L1 expression have significantly higher SUVmax (P = .01), MTV (P = .00), and TLG (P = .00) than patients with negative PD-L1 expression.18F-FDG PET/CT metabolic volume parameters (TLG ≥90.85 or MTV ≥14.87) were more helpful in prognostication than the conventional parameter (SUVmax), PD-L1 expression was an independent predictor of DFS in patients with resected LUAD. Metabolic parameters on 18F-FDG PET/CT have a potential role for 18F-FDG PET/CT in selecting candidate LUAD for treatment with checkpoint inhibitors.

Wang D ，Li Y ，Chen X ，Li P ... -  《-》

Predicting programmed death-ligand 1 (PD-L1) expression with fluorine-18 fluorodeoxyglucose ([(18)F]FDG) positron emission tomography/computed tomography (PET/CT) metabolic parameters in resectable non-small cell lung cancer.

Programmed death-ligand 1 (PD-L1) expression is a predictive biomarker for immunotherapy in non-small cell lung cancer (NSCLC). PD-L1 and glucose transporter 1 expression are closely associated, and studies demonstrate correlation of PD-L1 with glucose metabolism. The aim of this study was to investigate the association of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) metabolic parameters with PD-L1 expression in primary lung tumour and lymph node metastases in resected NSCLC. We conducted a retrospective analysis of 210 patients with node-positive resectable stage IIB-IIIB NSCLC. PD-L1 tumour proportion score (TPS) was determined using the DAKO 22C3 immunohistochemical assay. Semi-automated techniques were used to analyse pre-operative [18F]FDG-PET/CT images to determine primary and nodal metabolic parameter scores (including max, mean, peak and peak adjusted for lean body mass standardised uptake values (SUV), metabolic tumour volume (MTV), total lesional glycolysis (TLG) and SUV heterogeneity index (HISUV)). Patients were predominantly male (57%), median age 70 years with non-squamous NSCLC (68%). A majority had negative primary tumour PD-L1 (TPS < 1%; 53%). Mean SUVmax, SUVmean, SUVpeak and SULpeak values were significantly higher (p < 0.05) in those with TPS ≥ 1% in primary tumour (n = 210) or lymph nodes (n = 91). However, ROC analysis demonstrated only moderate separability at the 1% PD-L1 TPS threshold (AUCs 0.58-0.73). There was no association of MTV, TLG and HISUV with PD-L1 TPS. This study demonstrated the association of SUV-based [18F]FDG-PET/CT metabolic parameters with PD-L1 expression in primary tumour or lymph node metastasis in resectable NSCLC, but with poor sensitivity and specificity for predicting PD-L1 positivity ≥ 1%. Whilst SUV-based fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography metabolic parameters may not predict programmed death-ligand 1 positivity ≥ 1% in the primary tumour and lymph nodes of resectable non-small cell lung cancer independently, there is a clear association which warrants further investigation in prospective studies. Non-applicable KEY POINTS: • Programmed death-ligand 1 immunohistochemistry has a predictive role in non-small cell lung cancer immunotherapy; however, it is both heterogenous and dynamic. • SUV-based fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) metabolic parameters were significantly higher in primary tumour or lymph node metastases with positive programmed death-ligand 1 expression. • These SUV-based parameters could potentially play an additive role along with other multi-modal biomarkers in selecting patients within a predictive nomogram.

Hughes DJ ，Josephides E ，O'Shea R ，Manickavasagar T ，Horst C ，Hunter S ，Tanière P ，Nonaka D ，Van Hemelrijck M ，Spicer J ，Goh V ，Bille A ，Karapanagiotou E ，Cook GJR ... -  《-》

New insight on the correlation of metabolic status on (18)F-FDG PET/CT with immune marker expression in patients with non-small cell lung cancer.

Wang Y ，Zhao N ，Wu Z ，Pan N ，Shen X ，Liu T ，Wei F ，You J ，Xu W ，Ren X ... -  《-》

(18)F-FDG PET/CT imaging in pulmonary sarcomatoid carcinoma and correlation with clinical and genetic findings.

Wu X ，Huang Y ，Li Y ，Wang Q ，Wang H ，Jiang L ... -  《-》

The correlation between PD-L1 expression and metabolic parameters of (18)FDG PET/CT and the prognostic value of PD-L1 in non-small cell lung cancer.

In the present study, we aimed to investigate the relationship between metabolic parameters of 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) and the expression of programmed death ligand-1 (PD-L1), as well as the prognostic value of PD-L1, in patients with surgically resected non-small-cell lung cancer (NSCLC). A total of 169 NSCLC patients who received preoperative 18F-FDG PET were retrospectively enrolled in the present study. The correlation between PD-L1 and patient characteristics was evaluated. Based on the expression of PD-L1 and metabolic parameters, patients were classified into low-, medium-, or high-risk groups. The maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG) were significantly higher in NSCLC patients with high PD-L1 expression compared with the low expression group (P < 0.001 for all). Multivariate analysis revealed that pleural invasion (P < 0.001) and SUVmax (P < 0.001) were independent predictors of PD-L1 expression. Survival analysis showed that tumor stage (P = 0.004) and pleural invasion (P = 0.007) were independent prognostic indicators of progression-free survival (PFS). Tumor stage (P = 0.001), TLG (P = 0.039), and PD-L1 expression (P = 0.001) were independent prognostic indicators of overall survival (OS). Patients of the high-risk group with high PD-L1 expression and high TLG had a poor prognosis compared with the low-risk group (P < 0.05) and medium-risk group (P < 0.05). In NSCLC patients, the SUVmax of 18F-FDG PET/CT was a predictor of PD-L1 expression. The expression of PD-L1 and TLG were independent prognostic factors of OS. The risk stratification standard based on the PD-L1 expression and TLG provided valuable insights into the development of personalized treatment and follow-up. ChiCTR2100051554.

Xu X ，Li J ，Yang Y ，Sang S ，Deng S ... -  《-》