Seban Romain-David, Mezquita Laura, Berenbaum Arnaud, Dercle Laurent, Botticella Angela, Le Pechoux Cécile, Caramella Caroline, Deutsch Eric, Grimaldi Serena, Adam Julien, Ammari Samy, Planchard David, Leboulleux Sophie, Besse Benjamin
Gustave Roussy, Department of Nuclear Medicine and Endocrine Oncology, Université Paris-Saclay, Villejuif, France.
Gustave Roussy, Department of Medical Oncology, Thoracic Unit, Villejuif, France.
Eur J Nucl Med Mol Imaging. 2020 May;47(5):1147-1157. doi: 10.1007/s00259-019-04615-x. Epub 2019 Nov 21.
We aimed to evaluate if imaging biomarkers on FDG PET are associated with clinical outcomes in patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs).
In this retrospective monocentric study, we included 109 patients with advanced NSCLC who underwent baseline FDG PET/CT before ICI initiation between July 2013 and September 2018. Clinical, biological (including dNLR = neutrophils/[leukocytes minus neutrophils]), pathological and PET parameters (tumor SUVmax, total metabolic tumor volume [TMTV]) were evaluated. A multivariate prediction model was developed using Cox models for progression-free survival (PFS) and overall survival (OS). The association between biomarkers on FDG PET/CT and disease clinical benefit (DCB) was tested using logistic regression.
Eighty patients were eligible. Median follow-up was 11.6 months (95%CI 7.7-15.5). Sixty-four and 52 patients experienced progression and death, respectively. DCB was 40%. In multivariate analyses, TMTV > 75 cm and dNLR > 3 were associated with shorter OS (HR 2.5, 95%CI 1.3-4.7 and HR 3.3, 95%CI 1.6-6.4) and absence of DCB (OR 0.3, 95%CI 0.1-0.9 and OR 0.4, 95%CI 0.2-0.9). Unlike TMTV, dNLR was a significant prognostic factor for PFS (HR 1.9, 95%CI 1.1-3.3) along with anemia (HR 1.9, 95%CI 1.2-3.8). No association was observed between tumor SUVmax and PFS or OS.
Baseline tumor burden (TMTV) on FDG PET/CT scans and inflammatory status (dNLR) were associated with poor OS and absence of DCB for ICI treatment in advanced NSCLC patients, unlike tumor SUVmax, and may be used together to improve the selection of appropriate candidates.
我们旨在评估氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）上的影像生物标志物是否与接受免疫检查点抑制剂（ICI）治疗的晚期非小细胞肺癌（NSCLC）患者的临床结局相关。
在这项回顾性单中心研究中，我们纳入了109例在2013年7月至2018年9月期间开始ICI治疗前接受基线FDG PET/CT检查的晚期NSCLC患者。评估了临床、生物学（包括dNLR = 中性粒细胞/[白细胞减去中性粒细胞]）、病理和PET参数（肿瘤SUVmax、总代谢肿瘤体积 [TMTV]）。使用Cox模型建立了无进展生存期（PFS）和总生存期（OS）的多变量预测模型。使用逻辑回归检验FDG PET/CT上的生物标志物与疾病临床获益（DCB）之间的关联。
80例患者符合条件。中位随访时间为11.6个月（95%CI 7.7 - 15.5）。分别有64例和52例患者出现疾病进展和死亡。DCB为40%。在多变量分析中，TMTV > 75 cm和dNLR > 3与较短的OS（HR 2.5，95%CI 1.3 - 4.7和HR 3.3，95%CI 1.6 - 6.4）以及无DCB（OR 0.3，95%CI 0.1 - 0.9和OR 0.4，95%CI 0.2 - 0.9）相关。与TMTV不同，dNLR以及贫血（HR 1.9，95%CI 1.2 - 3.8）是PFS的显著预后因素（HR 1.9，95%CI 1.1 - 3.3）。未观察到肿瘤SUVmax与PFS或OS之间存在关联。
与肿瘤SUVmax不同，FDG PET/CT扫描上的基线肿瘤负荷（TMTV）和炎症状态（dNLR）与晚期NSCLC患者ICI治疗的OS不佳和无DCB相关，并且可一起用于改善合适候选者的选择。
