Prognostic Potential of Metabolic Activity on 18F-FDG Accumulation in Advanced NSCLC Receiving Combining Chemotherapy Plus PD-1 Blockade
Prognostic Potential of Metabolic Activity on 18F-FDG Accumulation in Advanced NSCLC Receiving Combining Chemotherapy Plus PD-1 Blockade
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DOI：
10.1097/cji.0000000000000434
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发表时间：
2022-08
影响因子：
3.9
通讯作者：
K. Hashimoto;K. Kaira;H. Imai;A. Mouri;A. Shiono;Y. Miura;O. Yamaguchi;K. Kobayashi;H. Kagamu-H.-Kagam
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文献类型：
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作者：
K. Hashimoto;K. Kaira;H. Imai;A. Mouri;A. Shiono;Y. Miura;O. Yamaguchi;K. Kobayashi;H. Kagamu-H.-Kagam
联合化疗加程序性死亡-1（PD-1）阻断剂是治疗晚期非小细胞肺癌（NSCLC）患者的既定治疗方法。然而，除了程序性死亡配体-1表达外，一个有希望的预测因子仍然不确定。我们研究了基线18F-FDG-正电子发射断层扫描对预测NSCLC患者一线联合化疗加PD-1阻滞剂的预后意义。45例晚期NSCLC患者在接受含铂化疗联合PD-1阻滞剂作为一线治疗前接受了18 F-FDG-正电子发射断层扫描，符合本研究的条件，并对18 F-FDG摄取的最大标准摄取值（SUVmax）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）进行了评估。客观缓解率、中位无进展生存期和总生存期分别为51.2%、206天和681天。高SUVmax、TLG和MTV分别与年龄和体能状态（PS）、C反应蛋白（CRP）以及PS、CRP、白蛋白和基线肿瘤大小显著相关。单因素分析显示，白蛋白、TLG和MTV是无进展生存期的重要预测因子，CRP、白蛋白、TLG和MTV是总生存期的重要预测因子。多因素分析证实高TLG是预后不良的独立相关因素。特别是，TLG被确定为PS良好、腺癌、程序性死亡配体-1 ≥ 1%和基线肿瘤大小较低的患者中最有力的预测因子。治疗前MTV和TLG的肿瘤代谢体积是联合化疗与PD-1阻断的重要预测因子，但SUVmax的最大糖酵解水平不是。
Combined chemotherapy plus programmed death-1 (PD-1) blockade is an established treatment against patients with advanced non–small cell lung cancer (NSCLC). However, a promising predictor besides programmed death ligand-1 expression remains uncertain. We examined the prognostic significance of baseline 18F-FDG-positron emission tomography for predicting first-line combined chemotherapy plus PD-1 blockade in NSCLC patients. Forty-five patients with advanced NSCLC who received 18F-FDG-positron emission tomography immediately before combined platinum-based chemotherapy with PD-1 blockade as first-line setting were eligible for this study, and assessment of maximum of standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on 18F-FDG uptake was performed. The objective response rate, median progression-free survival, and overall survival were 51.2%, 206 days, and 681 days, respectively. High SUVmax, TLG, and MTV significantly correlated with age and performance status (PS), C-reactive protein (CRP), and PS, CRP, albumin, and baseline tumor size, respectively. Univariate analysis identified albumin, TLG and MTV as significant predictors of progression-free survival, and CRP, albumin, TLG and MTV as significant factors for predicting overall survival. High TLG was confirmed as an independent factor associated with poor prognosis in multivariate analysis. In particular, TLG is identified as the most powerful predictor in patients with good PS, adenocarcinoma, programmed death ligand-1≥1%, and low baseline tumor size. The tumor metabolic volume by MTV and TLG at pretreatment was clarified as a significant predictor for combined chemotherapy with PD-1 blockade, but not maximal glycolytic level by SUVmax.