Chen Xiaowei, Bai Guangyu, Zang Ruochuan, Song Peng, Bie Fenglong, Huai Qilin, Li Yuan, Liu Yang, Zhou Bolun, Bie Yifan, Yang Zhenlin, Gao Shugeng
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
Transl Oncol. 2023 Sep;35:101725. doi: 10.1016/j.tranon.2023.101725. Epub 2023 Jul 6.
The aim of present study was to investigate the efficiency of F-FDG uptake in predicting major pathological response (MPR) in resectable non-small cell lung cancer (NSCLC) patients with neoadjuvant immunotherapy.
A total of 104 patients with stage I-IIIB NSCLC were retrospectively derived from National Cancer Center of China, of which 36 cases received immune checkpoint inhibitors (ICIs) monotherapy (I-M) and 68 cases with ICI combination therapy (I-C). F-FDG PET-CT scans were performed at baseline and after neoadjuvant therapy (NAT). Receiver-operating characteristic (ROC) curve analyses were conducted and area under ROC curve (AUC) was calculated for biomarkers including maximum standardized uptake value (SUVmax), inflammatory biomarkers, tumor mutation burden (TMB), PD-L1 tumor proportion score (TPS) and iRECIST.
Fifty-four resected NSCLC tumors achieved MPR (51.9%, 54/104). In both neoadjuvant I-M and I-C cohorts, post-NAT SUVmax and the percentage changes of SUVmax (ΔSUVmax%) were significantly lower in the patients with MPR versus non-MPR (p < 0.01), and were also negatively correlated with the degree of pathological regression (p < 0.01). The AUC of ΔSUVmax% for predicting MPR was respectively 1.00 (95% CI: 1.00-1.00) in neoadjuvant I-M cohort and 0.94 (95% CI: 0.86-1.00) in I-C cohort. Baseline SUVmax had a statistical prediction value for MPR only in I-M cohort, with an AUC up to 0.76 at the threshold of 17.0. ΔSUVmax% showed an obvious advantage in MPR prediction over inflammatory biomarkers, TMB, PD-L1 TPS and iRECIST.
F-FDG uptake can predict MPR in NSCLC patients with neoadjuvant immunotherapy.
本研究旨在探讨¹⁸F-氟脱氧葡萄糖（¹⁸F-FDG）摄取在预测可切除的非小细胞肺癌（NSCLC）患者接受新辅助免疫治疗后的主要病理缓解（MPR）方面的效能。
回顾性分析来自中国国家癌症中心的104例Ⅰ-ⅢB期NSCLC患者，其中36例接受免疫检查点抑制剂（ICI）单药治疗（I-M），68例接受ICI联合治疗（I-C）。在基线期和新辅助治疗（NAT）后进行¹⁸F-FDG PET-CT扫描。进行受试者操作特征（ROC）曲线分析，并计算包括最大标准化摄取值（SUVmax）、炎症生物标志物、肿瘤突变负荷（TMB）、程序性死亡配体1肿瘤比例评分（PD-L1 TPS）和免疫治疗疗效评价标准（iRECIST）等生物标志物的ROC曲线下面积（AUC）。
54例接受手术切除的NSCLC肿瘤达到MPR（51.9%，54/104）。在新辅助I-M和I-C队列中，达到MPR的患者NAT后的SUVmax及SUVmax变化百分比（ΔSUVmax%）均显著低于未达到MPR的患者（p<0.01），且与病理退缩程度呈负相关（p<0.01）。新辅助I-M队列中ΔSUVmax%预测MPR的AUC为1.00（95%CI：1.00-1.00），I-C队列中为0.94（95%CI：0.86-1.00）。基线SUVmax仅在I-M队列中对MPR有统计学预测价值，在阈值为17.0时AUC高达0.76。ΔSUVmax%在MPR预测方面比炎症生物标志物、TMB、PD-L1 TPS和iRECIST具有明显优势。
¹⁸F-FDG摄取可预测接受新辅助免疫治疗的NSCLC患者的MPR。
