Research Article
Year 2025,
, 164 - 173, 01.01.2025
Abstract
References
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- 18. Reck M, Rodríguez-Abreu D, Robinson AG, et al. Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-Small-Cell Lung Cancer. N Engl J Med. 2016;375:1823-33.
- 19. Aguilar E, Ricciuti B, Gainor J, et al. Outcomes to first-line pembrolizumab in patients with non-small-cell lung cancer and very high PD-L1 expression. Ann Oncol. 2019;30:1653-59.
- 20. Cafaro A, Foca F, Nanni O, et al. Real-World Safety and Outcome of First-Line Pembrolizumab Monotherapy for Metastatic NSCLC with PDL-1 Expression ≥ 50%: A National Italian Multicentric Cohort ("PEMBROREAL" Study). Cancers (Basel). 2024;16:1802.
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- 23. Hu B, Xiao J, Xiu Y, et al. Correlation of PD-L1 expression on tumor cell and tumor infiltrating immune cell with 18F-fluorodeoxyglucose uptake on PET/computed tomography in surgically resected pulmonary adenocarcinoma. Nucl Med Commun 2020; 41:252–9.
- 24. Monaco L, De Bernardi E, Bono F, et al. The "digital biopsy" in non-small cell lung cancer (NSCLC): a pilot study to predict the PD-L1 status from radiomics features of [18F]FDG PET/CT. Eur J Nucl Med Mol Imaging. 2022;49:3401-11.
- 25. Xu X, Li J, Yang Y, et al. The correlation between PD-L1 expression and metabolic parameters of 18FDG PET/CT and the prognostic value of PD-L1 in non-small cell lung cancer. Clin Imaging. 2022;89:120-7.
- 26. Norikane T, Ishimura M, Mitamura K, et al. Texture Features of 18F-Fluorodeoxyglucose Positron Emission Tomography for Predicting Programmed Death-Ligand-1 Levels in Non-Small Cell Lung Cancer. J Clin Med. 2024;13:1625.
- 27. Li J, Ge S, Sang S, et al. Evaluation of PD-L1 Expression Level in Patients With Non-Small Cell Lung Cancer by 18F-FDG PET/CT Radiomics and Clinicopathological Characteristics. Front Oncol. 2021;11:789014.
- 28. Cui, Y., and X. Li. PD-L1 in Lung Adenocarcinoma: Insights into the Role of 18F-FDG PET/CT. Cancer Manag Res. 2020;12:6385-95.
- 29. Wu X, Huang Y, Zhao Q, et al. PD-L1 expression correlation with metabolic parameters of FDG PET/CT and clinicopathological characteristics in non-small cell lung cancer. EJNMMI Res. 2020;10:51.
- 30. Wang D, Li Y, Chen X, et al. Prognostic significance of volume-based 18F-FDG PET/CT parameters and correlation with PD-L1 expression in patients with surgically resected lung adenocarcinoma. Medicine (Baltimore). 2021;100:e27100.
Baseline 18F FDG PET/CT imaging in NSCLC: Possible utility in predicting strong-positive PD-L1 expression
Abstract
Background/Purpose: To assess whether 18F FDG PET/CT imaging can predict non-small cell lung cancer (NSCLC) patients with strong PD-L1 expression (≥50%).
Methods: This retrospective study analyzed 149 NSCLC patients who had undergone baseline 18F FDG PET/CT imaging from June 2021 to May 2024. We recorded age, sex, smoking history, histopathology, TNM stage, metastasis, and PD-L1 expression levels. PET/CT parameters such as SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were recorded. Patients were dichotomized based on two PD-L1 expression thresholds, as measured by immunohistochemistry: higher or lower than 1% (<1%, n = 62 versus >1%, n = 87) and higher or lower than 50% (<50%, n = 100 versus ≥50%, n = 39).
Results: No significant results were found for the comparison of PD-L1 negative (<1%) and positive (≥1%) patients. The <50% and ≥50% groups were similar in terms of all examined characteristics and PET/CT parameters except for TLG, which was significantly higher among patients with strong PD-L1 expression. ROC analysis revealed an area under curve of 0.606 (95% CI: 0.508–0.705, p = 0.049) for the discrimination of patients with and without strong PD-L1 expression, yielding 89.7% sensitivity, 30% specificity, and 45.6% overall accuracy.
Conclusion: This study identified TLG as a potential predictor for NSCLC patients with strong PD-L1 expression (≥50%) based on 18F FDG PET/CT imaging, despite low accuracy. High sensitivity and negative predictive value suggest a role as a supportive tool in screening.
Keywords
18F-fluorodeoxyglucose positron emission tomography programmed death-ligand-1 non-small cell lung cancer
Supporting Institution
yok
References
- 1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209-49.
- 2. Hellmann MD, Li BT, Chaft JE, et al. Chemotherapy remains an essential element of personalized care for persons with lung cancers. Ann Oncol. 2016;27:1829-35.
- 3. Iwai Y, Ishida M, Tanaka Y, et al. Involvement of PD-L1 on tumor cells in the escape from host immune system and tumor immunotherapy by PD-L1 blockade. Proc Natl Acad Sci USA 2002;99:12293–97.”
- 4. Zhang J, Dang F, Ren J, et al. Biochemical aspects of PD-L1 regulation in cancer immunotherapy. Trends Biochem Sci. 2018;43:1014-32.
- 5. Liu X, Guo CY, Tou FF, et al. Association of PD-L1 expression status with the efficacy of PD-1/PD-L1 inhibitors and overall survival in solid tumours: a systematic review and meta-analysis. Int J Cancer. 2020;147:116-27.
- 6. Grant MJ, Herbst RS and Goldberg SB. Selecting the optimal immunotherapy regimen in drivernegative metastatic NSCLC. Nat Rev Clin Oncol 2021;18: 625-44.
- 7. Sacher, AG, and L. Gandhi. Biomarkers for the clinical use of PD-1/PD-L1 inhibitors in non-small-cell lung cancer: a review. JAMA Oncol. 2016;2:1217–22.
- 8. Genentech Inc. Administration USFaD. Tecentriq (Atezolizumab) [Package Insert], Full Prescribing Information. U.S. Food and Drug Administration; 2023.
- 9. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Non-small Cell Lung Cancer version 4.2021, 2021.
- 10. Bubendorf L, Lantuejoul S, de Langen AJ, et al. Nonsmall cell lung carcinoma: diagnostic difficulties in small biopsies and cytological specimens: Number 2 in the Series “Pathology for the clinician” Edited by Peter Dorfmüller and Alberto Cavazza. Eur Respir Rev. 2017;26:170007.
- 11. Takada K, Toyokawa G, Okamoto T, et al. Metabolic characteristics of programmed cell death-ligand 1-expressing lung cancer on (18) Fluorodeoxyglucose positron emission tomography/computed tomography. Cancer Med. 2017;6:2552-61.
- 12. Kaira K, Shimizu K, Kitahara S, et al. 2-Deoxy-2-[fluorine-18] fluoro-d-glucose uptake on positron emission tomography is associated with programmed death ligand-1 expression in patients with pulmonary adenocarcinoma. Eur J Cancer. 2018;101:181–90.
- 13. Detterbeck FC, Boffa DJ, Kim AW, et al. The Eighth Edition Lung Cancer Stage Classiffication. Chest 2017; 51:193-203.
- 14. Boellaard R, Delgado-Bolton R, Oyen WJ, et al. European Association of Nuclear Medicine (EANM). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 2015;42:328–54.
- 15. Sezer A, Kilickap S, Gümüş M, et al Cemiplimab monotherapy for first-line treatment of advanced non-small-cell lung cancer with PD-L1 of at least 50%: a multicentre, open-label, global, phase 3, randomised, controlled trial. Lancet. 2021;397:592-604. LANCET.
- 16. Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer. N Engl J Med. 2015;373:1627-39.
- 17. Garon EB, Rizvi NA, Hui R, et al. Pembrolizumab for the treatment of non-small-cell lung cancer. N Engl J Med., 2015;372:2018-28.
- 18. Reck M, Rodríguez-Abreu D, Robinson AG, et al. Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-Small-Cell Lung Cancer. N Engl J Med. 2016;375:1823-33.
- 19. Aguilar E, Ricciuti B, Gainor J, et al. Outcomes to first-line pembrolizumab in patients with non-small-cell lung cancer and very high PD-L1 expression. Ann Oncol. 2019;30:1653-59.
- 20. Cafaro A, Foca F, Nanni O, et al. Real-World Safety and Outcome of First-Line Pembrolizumab Monotherapy for Metastatic NSCLC with PDL-1 Expression ≥ 50%: A National Italian Multicentric Cohort ("PEMBROREAL" Study). Cancers (Basel). 2024;16:1802.
- 21. Cavazzoni A, Digiacomo G, Volta F, et al. PD-L1 overexpression induces STAT signaling and promotes the secretion of pro-angiogenic cytokines in non-small cell lung cancer (NSCLC). Lung Cancer. 2024;187:107438.
- 22. Hu B, Chen W, Zhang Y, et al. 18F-FDG maximum standard uptake value predicts PD-L1 expression on tumor cells or tumor infiltrating immune cells in non-small cell lung cancer. Ann Nucl Med 2020;34:322-8.
- 23. Hu B, Xiao J, Xiu Y, et al. Correlation of PD-L1 expression on tumor cell and tumor infiltrating immune cell with 18F-fluorodeoxyglucose uptake on PET/computed tomography in surgically resected pulmonary adenocarcinoma. Nucl Med Commun 2020; 41:252–9.
- 24. Monaco L, De Bernardi E, Bono F, et al. The "digital biopsy" in non-small cell lung cancer (NSCLC): a pilot study to predict the PD-L1 status from radiomics features of [18F]FDG PET/CT. Eur J Nucl Med Mol Imaging. 2022;49:3401-11.
- 25. Xu X, Li J, Yang Y, et al. The correlation between PD-L1 expression and metabolic parameters of 18FDG PET/CT and the prognostic value of PD-L1 in non-small cell lung cancer. Clin Imaging. 2022;89:120-7.
- 26. Norikane T, Ishimura M, Mitamura K, et al. Texture Features of 18F-Fluorodeoxyglucose Positron Emission Tomography for Predicting Programmed Death-Ligand-1 Levels in Non-Small Cell Lung Cancer. J Clin Med. 2024;13:1625.
- 27. Li J, Ge S, Sang S, et al. Evaluation of PD-L1 Expression Level in Patients With Non-Small Cell Lung Cancer by 18F-FDG PET/CT Radiomics and Clinicopathological Characteristics. Front Oncol. 2021;11:789014.
- 28. Cui, Y., and X. Li. PD-L1 in Lung Adenocarcinoma: Insights into the Role of 18F-FDG PET/CT. Cancer Manag Res. 2020;12:6385-95.
- 29. Wu X, Huang Y, Zhao Q, et al. PD-L1 expression correlation with metabolic parameters of FDG PET/CT and clinicopathological characteristics in non-small cell lung cancer. EJNMMI Res. 2020;10:51.
- 30. Wang D, Li Y, Chen X, et al. Prognostic significance of volume-based 18F-FDG PET/CT parameters and correlation with PD-L1 expression in patients with surgically resected lung adenocarcinoma. Medicine (Baltimore). 2021;100:e27100.
There are 30 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Radiology and Organ Imaging |
| Journal Section | Clinical Research |
| Authors | |
| Early Pub Date | December 10, 2024 |
| Publication Date | January 1, 2025 |
| Submission Date | September 14, 2024 |
| Acceptance Date | November 19, 2024 |
| Published in Issue | Year 2025 |