Hu Bingxin, Jin Huibin, Li Xiali, Wu Xinyu, Xu Junling, Gao Yongju
Department of Nuclear Medicine, Henan Key Laboratory of Novel Molecular Probes and Clinical Translation in Nuclear Medicine, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou University, Zhengzhou, China.
Front Oncol. 2022 Sep 23;12:943933. doi: 10.3389/fonc.2022.943933. eCollection 2022.
Total-body positron emission tomography/computed tomography (PET/CT) provides faster scanning speed, higher image quality, and lower injected dose. To compensate for the shortcomings of the maximum standard uptake value (SUVmax), we aimed to normalize the values of PET parameters using liver and blood pool SUV (SUR-L and SUR-BP) to predict programmed cell death-ligand 1 (PD-L1) expression in non-small cell lung cancer (NSCLC) patients.
A total of 138 (104 adenocarcinoma and 34 squamous cell carcinoma) primary diagnosed NSCLC patients who underwent F-FDG-PET/CT imaging were analyzed retrospectively. Immunohistochemistry (IHC) analysis was performed for PD-L1 expression on tumor cells and tumor-infiltrating immune cells with 22C3 antibody. Positive PD-L1 expression was defined as tumor cells no less than 50% or tumor-infiltrating immune cells no less than 10%. The relationships between PD-L1 expression and PET parameters (SUVmax, SUR-L, and SUR-BP) and clinical variables were analyzed. Statistical analysis included χ test, receiver operating characteristic (ROC), and binary logistic regression.
There were 36 patients (26%) expressing PD-L1 positively. Gender, smoking history, Ki-67, and histologic subtype were related factors. SUVmax, SUR-L, and SUR-BP were significantly higher in the positive subset than those in the negative subset. Among them, the area under the curve (AUC) of SUR-L on the ROC curve was the biggest one. In NSCLC patients, the best cutoff value of SUR-L for PD-L1-positive expression was 4.84 (AUC = 0.702, P = 0.000, sensitivity = 83.3%, specificity = 54.9%). Multivariate analysis confirmed that age and SUR-L were correlated factors in adenocarcinoma (ADC) patients.
SUVmax, SUR-L, and SUR-BP had utility in predicting PD-L1 high expression, and SUR-L was the most reliable parameter. PET/CT can offer reference to screen patients for first-line atezolizumab therapy.
全身正电子发射断层扫描/计算机断层扫描（PET/CT）具有更快的扫描速度、更高的图像质量和更低的注射剂量。为弥补最大标准摄取值（SUVmax）的不足，我们旨在使用肝脏和血池SUV（SUR-L和SUR-BP）对PET参数值进行标准化，以预测非小细胞肺癌（NSCLC）患者程序性细胞死亡配体1（PD-L1）的表达。
回顾性分析138例（104例腺癌和34例鳞状细胞癌）经F-FDG-PET/CT成像初诊的NSCLC患者。用22C3抗体对肿瘤细胞和肿瘤浸润免疫细胞进行PD-L1表达的免疫组织化学（IHC）分析。PD-L1阳性表达定义为肿瘤细胞不少于50%或肿瘤浸润免疫细胞不少于10%。分析PD-L1表达与PET参数（SUVmax、SUR-L和SUR-BP）及临床变量之间的关系。统计分析包括χ检验、受试者工作特征（ROC）曲线和二元逻辑回归。
36例（26%）患者PD-L1阳性表达。性别、吸烟史、Ki-67和组织学亚型是相关因素。阳性亚组的SUVmax、SUR-L和SUR-BP显著高于阴性亚组。其中，ROC曲线上SUR-L的曲线下面积（AUC）最大。在NSCLC患者中，SUR-L对PD-L1阳性表达的最佳截断值为4.84（AUC = 0.702，P = 0.000，灵敏度 = 83.3%，特异性 = 54.9%）。多因素分析证实年龄和SUR-L是腺癌（ADC）患者的相关因素。
SUVmax、SUR-L和SUR-BP在预测PD-L1高表达方面具有实用价值，且SUR-L是最可靠的参数。PET/CT可为一线阿特珠单抗治疗患者的筛选提供参考。
