18 F-FDG PET/CT for evaluation of metastases in nonsmall cell lung cancer on the efficacy of immunotherapy

Yawen Feng, Peng Wang, Yuqi Chen, Wenli Dai, Yawen Feng, Peng Wang, Yuqi Chen, Wenli Dai

Abstract

Objective: This study aimed to investigate the relationship between 18 F-fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) metabolic parameters and clinical benefit and prognosis in nonsmall cell lung cancer (NSCLC).

Methods: In total, 34 advanced NSCLC patients who received 18 F-FDG PET/CT before immunotherapy were retrospectively included in this study. All patients were divided into two groups, the clinical benefit (CB) group and the no-clinical benefit (no-CB) group, based on the efficacy of evaluation after 6 months of treatment. Also clinical information, characteristics of metastases, survival, PD-L1 expression level and glucose metabolic parameters were evaluated.

Results: Finally, 24 patients were in the CB group, and 10 patients were in the no-CB group. There was a significant difference between the CB group and the no-CB group in TNM stages ( P = 0.005), visceral and bone metastasis ( P = 0.031), metabolic tumor volume of primary lesion (MTV-P; P = 0.003), the metabolic tumor volume of whole-body (MTVwb; P = 0.005) and total lesion glycolysis of whole-body (TLGwb, P = 0.015). However, for patient outcomes, the independent prognostic factors associated with progression free survival were TNM stage (HR = 0.113; 95% CI, 0.029-0.439; P = 0.002), TLG-P (HR = 0.085; 95% CI, 0.018-0.402; P = 0.002) and TLG-LN (HR = 0.068; 95% CI, 0.015-0.308; P = 0.000), and the TLG-LN (HR = 0.242; 95% CI, 0.066-0.879; P = 0.002) was the independent prognostic factor associated with overall survival.

Conclusions: Metastatic lesion burden evaluated by 18 F-FDG PET/ CT can predict response to immunotherapy in advanced NSCLC patients, in which lymph node metastasis lesion metabolic burden is a meaningful predictor, but a large multicenter trial is still needed to validate this conclusion.

Conflict of interest statement

There are no conflicts of interest.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Fig. 1
Fig. 1
Survival of NSCLC patients with immunotherapy. Kaplan–Meier survival curves of progression-free survival (a) and overall survival (b) of the CB group and no-CB group.
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve analyses for the optimal cutoff value of 18F-FDG positron emission tomography (PET) metabolic parameters. The area under the ROC curve (AUC) with the corresponding 95% confidence interval (CI) is in this report.
Fig. 3
Fig. 3
Kaplan–Meier diagram. Independent impact factors related to progression-free survival and overall survival. There is a statistically significant difference between the progression-free survival of TNM stage III and TNM stage IV (P = 0.028) (a), TLG-P≤391.85 and TLG-P>391.85 (P = 0.005) (b), TLG-LN≤61.06 and TLG-LN>61.06 (P = 0.0033) (c). And the TLG-LN≤61.06 and TLG-LN>61.06 is the independent impact factors for overall survival (d). The reported P value is the result of the log-rank test, and the P value < 0.05 was considered statistically significant.
Fig. 4
Fig. 4
MIP image of different tumor metabolism burdens in the coronal plane. The MIP image of this 54-year-old male patient shows only the primary lung lesions (a). There were no lymph nodes and distant visceral and bone metastasis. The MTVwb was 80.81 and the TLGwb was 368.49. He was treated with Durvalumab, and no progression of the patient’s disease was detected by the cutoff time point of the follow-up period, the PFS time was 21.67 months. (b) was a 65-year-old female patient. MIP image revealed a right upper lung lobe occupancy, mediastinal and left supraclavicular lymph node metastasis, the MTVwb was 409.86, and the TLGwb was 3046.16. This patient was treated with Sindilizumab, and eventually, her disease progressed, the PFS time was 13.97 months. (c) was a 58-year-old male. MIP image shows a mass in the lower lobe of the right lung, lymph nodes, liver, and spleen metastasis, the MTVwb was 102.55, and the TLGwb was 610.35. He was treated with Sintilimab, but the treatment was poor and disease progression quickly occurred, the PFS time was 2.77 months, and the OS time was 7.27 months. Red markers are lung lesions, blue markers are lymph node metastases, and green markers are metastases to visceral organs and bone. MIP, maximum intensity projection; MTVwb, the metabolic tumor volume of whole-body; TLGwb, total lesion glycolysis of whole-body; PFS, progression-free survival; OS, overall survival.

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