Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Lung Cancer. 2023 Apr;178:20-27. doi: 10.1016/j.lungcan.2023.02.001. Epub 2023 Feb 3.
Reliable predictive markers are lacking for resectable non-small cell lung cancer (NSCLC) patients treated with neoadjuvant chemoimmunotherapy. The present study investigated the utility of SUV values acquired from PET/CT to predict the response to neoadjuvant chemoimmunotherapy for resectable NSCLC.
SUV, clinical and pathological outcomes, were collected from patients in 5 hospitals. Patients who received dynamic PET/CT surveillance were divided into cohorts A (chemoimmunotherapy) and B (chemotherapy), respectively, while cohort C (chemoimmunotherapy) comprised patients undergoing post-therapy PET/CT. Associations between SUV and major pathologic response (MPR) were evaluated through receiver operating characteristic (ROC) curves.
A total of 129 cases with an MPR rate of 46.5 % was identified. In neoadjuvant chemoimmunotherapy, ΔSUV% (AUC: 0.890, 95 % CI: 0.761-0.949) and post-therapy SUV (AUC: 0.933, 95 % CI: 0.802-0.959) could accurately predict MPR. On the contrary, the baseline SUV was not associated with MPR (p = 0.184). Furthermore, an independent cohort C proved that post-therapy SUV could serve as an independent predictor (AUC: 0.928, 95 % CI: 0.823-0.958). In addition, robust predictive performance could be observed when we use the optimal cut-off point of both ΔSUV% (54.4 %, AUC: 0.912, 95 % CI: 0.824-0.994) and post-therapy SUV (3.565, AUC: 0.912, 95 % CI: 0.824-0.994) in neoadjuvant chemoimmunotherapy. The RNA data revealed that the expression of PFKFB4, a key enzyme in glycolysis, was positively correlated with SUV value and tumor cell proliferation after neoadjuvant chemoimmunotherapy.
These findings highlighted that the ΔSUV% and remained SUV were accurate and non-invasive tests for the prediction of MPR after neoadjuvant chemoimmunotherapy.
对于接受新辅助化疗免疫治疗的可切除非小细胞肺癌（NSCLC）患者，缺乏可靠的预测标志物。本研究旨在探讨 PET/CT 获得的 SUV 值在预测可切除 NSCLC 新辅助化疗免疫治疗反应中的作用。
收集 5 家医院患者的 SUV 值、临床和病理结果。接受动态 PET/CT 监测的患者分别分为 A 组（化疗免疫治疗）和 B 组（化疗），而 C 组（化疗免疫治疗）包括接受治疗后 PET/CT 的患者。通过受试者工作特征（ROC）曲线评估 SUV 与主要病理反应（MPR）之间的相关性。
共纳入 129 例 MPR 率为 46.5%的患者。在新辅助化疗免疫治疗中，ΔSUV%（AUC：0.890，95%CI：0.761-0.949）和治疗后 SUV（AUC：0.933，95%CI：0.802-0.959）可准确预测 MPR。相反，基线 SUV 与 MPR 无关（p=0.184）。此外，独立的 C 队列证明治疗后 SUV 可作为独立预测因子（AUC：0.928，95%CI：0.823-0.958）。此外，当我们使用新辅助化疗免疫治疗中 ΔSUV%（54.4%，AUC：0.912，95%CI：0.824-0.994）和治疗后 SUV（3.565，AUC：0.912，95%CI：0.824-0.994）的最佳截断值时，也可以观察到稳健的预测性能。RNA 数据显示，糖酵解关键酶 PFKFB4 的表达与新辅助化疗免疫治疗后 SUV 值和肿瘤细胞增殖呈正相关。
这些发现强调了ΔSUV%和残留 SUV 是新辅助化疗免疫治疗后预测 MPR 的准确、非侵入性检测方法。
