The role of baseline F-FDG PET/CT for survival prognosis in NSCLC patients undergoing immunotherapy: a systematic review and meta-analysis.

BACKGROUND

The value of pretreatment baseline F-fluorodeoxyglucose positron emission tomography (F-FDG PET)/computed tomography (CT) as a prognostic factor for survival of patients with non-small-cell lung cancer (NSCLC) receiving immunotherapy remained uncertain.

OBJECTIVES

To investigate the prognostic ability of baseline F-FDG PET/CT in patients with NSCLC receiving immunotherapy.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES AND METHODS

We searched the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases until May 7, 2024, and extracted data related to patient characteristics, semiquantitative parameters of F-FDG PET/CT, and survival. We pooled hazard ratios (HRs) to evaluate the prognostic value of the maximum standardized uptake value (SUV), mean standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for overall survival (OS) and progression-free survival (PFS).

RESULTS

A total of 22 studies (1363 patients, average age range 30-88 years) were included. Baseline F-FDG PET/CT-derived MTV was significantly associated with both OS (HR: 1.124, 95% confidence interval (CI) 1.058-1.195,  = 81.70%) and PFS (HR: 1.069, 95% CI: 1.016-1.124,  = 71.80%). Other baseline F-FDG PET/CT-derived parameters, including SUV (OS: HR: 0.930, 95% CI: 0.718-1.230; PFS: HR: 0.979, 95% CI: 0.759-1.262), SUV (OS: HR: 0.801, 95% CI: 0.549-1.170; PFS: HR: 0.688, 95% CI: 0.464-1.020), and TLG (OS: HR: 0.999, 95% CI: 0.980-1.018; PFS: HR: 0.995, 95% CI: 0.980-1.010), were not associated with survival. Sensitivity analyses by removing one study at a time did not significantly alter the association between MTV and PFS or between MTV and OS. There was no evidence of publication bias.

CONCLUSION

Pretreatment baseline F-FDG PET/CT-derived MTV might be a prognostic biomarker in NSCLC patients receiving immunotherapy. Further studies are needed to support routine use.