Department of PET/CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
Department of PET/CT, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province, China.
Medicine (Baltimore). 2021 Sep 3;100(35):e27100. doi: 10.1097/MD.0000000000027100.
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.
本研究旨在回顾性分析 18F-FDG 正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）代谢变量、程序性死亡配体 1（PD-L1）和磷酸化信号转导和转录激活因子 3（p-STAT3）肿瘤表达以及其他因素，作为接受手术切除的肺腺癌（LUAD）（IA-IIIA 期）患者无病生存（DFS）的预测因子。我们仍然缺乏免疫检查点（程序性死亡-1 [PD-1]/PD-L1）抑制剂的预测因子。在此，我们研究了 18F-FDG PET/CT 代谢参数与接受手术切除的 LUAD 患者 PD-L1 表达之间的相关性。连续纳入了 74 例在治疗前接受 18F-FDG PET/CT 检查的患者。主要的 18F-FDG PET/CT 衍生变量是原发肿瘤最大标准化摄取值（SUVmax）、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）。使用免疫组织化学分析手术肿瘤标本的 PD-L1 和 p-STAT3 表达。比较免疫组化结果与 18F-FDG PET/CT 衍生变量之间的相关性。评估 PD-L1 和 p-STAT3 肿瘤表达、18F-FDG PET/CT 衍生变量和其他因素与 LUAD 切除后 DFS 的关系。所有肿瘤均摄取 FDG。低 SUVmax、MTV 和 TLG 的截断值分别为 12.60、14.87 和 90.85。结果表明，TNM 分期、PD-L1 阳性和高 18F-FDG PET/CT 代谢体积参数（TLG≥90.85 或 MTV≥14.87）是 LUAD 切除后DFS 较差的独立预测因子。未观察到与 PD-L1 表达相关的 18F-FDG 代谢参数（卡方检验），但我们发现，与 PD-L1 阴性表达的患者相比，PD-L1 阳性表达的患者 SUVmax（P=0.01）、MTV（P=0.00）和 TLG（P=0.00）明显更高。18F-FDG PET/CT 代谢体积参数（TLG≥90.85 或 MTV≥14.87）比常规参数（SUVmax）更有助于预后，PD-L1 表达是 LUAD 患者 DFS 的独立预测因子。18F-FDG PET/CT 上的代谢参数在选择 LUAD 患者接受检查点抑制剂治疗方面具有潜在作用。
