Hashimoto Kosuke, Kaira Kyoichi, Mouri Atsuto, Shiono Ayako, Miura Yu, Yamaguchi Ou, Imai Hisao, Kagamu Hiroshi, Kuji Ichiei
Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan.
Department of Nuclear Medicine, International Medical Center, Saitama Medical University, Saitama, Japan.
Transl Lung Cancer Res. 2025 Apr 30;14(4):1242-1253. doi: 10.21037/tlcr-2024-1084. Epub 2025 Apr 27.
Nivolumab plus ipilimumab (Nivo-Ipi) is a standard treatments for metastatic or recurrent non-small cell lung cancer (NSCLC). Unlike programmed death-1 (PD-1) inhibitor monotherapy, the possible predictors of Nivo-Ipi treatment effectiveness remain unclear. Therefore, this retrospective study evaluated the prognostic relevance of 2-deoxy-2-[fluorine-18]-fluoro-d-glucose positron emission tomography (F-FDG PET) after Nivo-Ipi treatment in patients with advanced NSCLC.
Among 130 eligible patients with metastatic or recurrent NSCLC who received Nivo-Ipi as initial treatment and underwent F-FDG PET prior to the initial treatment, the maximum standardized uptake value (SUV), SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on F-FDG uptake were evaluated.
High MTV and TLG on F-FDG uptake were significantly associated with poor performance status (PS), no response, high neutrophil-to-leukocyte ratio (NLR), low albumin levels, and high C-reactive protein (CRP) level, while SUV and SUV showed no significant associations. Univariate analysis of all patients identified PS, bone metastases, NLR, MTV, and TLG as significant predictors of prognosis. By multivariate analysis, NLR and MTV were identified as independent predictors of prognosis. Sub-analysis based on histology and programmed death ligand-1 (PD-L1) expression identified MTV as an independent prognostic predictor for Nivo-Ipi treatment in patients with histological findings of adenocarcinoma (AC) and PD-L1 <1%. A high MTV with poor outcome was closely associated with a poor PS, lymph node metastases, bone metastases, high NLR, low albumin levels, and high CRP level.
MTV determined based on F-FDG uptake was a negative prognostic factor after Nivo-Ipi treatment, particularly in patients with histological findings of AC or PD-L1 <1%.
纳武利尤单抗联合伊匹木单抗（Nivo-Ipi）是转移性或复发性非小细胞肺癌（NSCLC）的标准治疗方案。与程序性死亡-1（PD-1）抑制剂单药治疗不同，Nivo-Ipi治疗效果的可能预测因素仍不明确。因此，本回顾性研究评估了晚期NSCLC患者接受Nivo-Ipi治疗后2-脱氧-2-[氟-18]-氟-D-葡萄糖正电子发射断层扫描（F-FDG PET）的预后相关性。
在130例符合条件的转移性或复发性NSCLC患者中，这些患者接受Nivo-Ipi作为初始治疗，并在初始治疗前接受了F-FDG PET检查，评估了F-FDG摄取时的最大标准化摄取值（SUV）、SUV、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）。
F-FDG摄取时的高MTV和TLG与较差的体能状态（PS）、无反应、高中性粒细胞与白细胞比值（NLR）、低白蛋白水平和高C反应蛋白（CRP）水平显著相关，而SUV和SUV未显示出显著相关性。对所有患者的单因素分析确定PS、骨转移、NLR、MTV和TLG为预后的显著预测因素。通过多因素分析，NLR和MTV被确定为预后的独立预测因素。基于组织学和程序性死亡配体-1（PD-L1）表达的亚组分析确定MTV是组织学结果为腺癌（AC）且PD-L1<1%的患者接受Nivo-Ipi治疗的独立预后预测因素。MTV高且预后差与PS差、淋巴结转移、骨转移、NLR高、白蛋白水平低和CRP水平高密切相关。
基于F-FDG摄取确定的MTV是Nivo-Ipi治疗后的不良预后因素，尤其是在组织学结果为AC或PD-L1<1%的患者中。
