Abstract
PurposeThis research aims to investigate the predictive capacity of PET/CT quantitative parameters combined with haematological parameters in advanced lung cancer patients treated with immune checkpoint inhibitor (ICI) plus chemotherapy.MethodsA total of 120 patients who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) were enrolled before therapy. The following parameters were calculated: the maximum, mean, and peak standardized uptake value (SUVmax, SUVmean, and SUVpeak, respectively); total tumour volume (MTV) and total lesion glycolysis (TLG); and whole-body metabolic values (MTVwb, TLGwb, SUVmeanwb, and SUVmaxwb). Lactate dehydrogenase (LDH) levels, absolute neutrophil count, absolute platelet count, albumin levels and derived neutrophil to lymphocyte ratio (dNLR) were also computed. The associations between the variables and therapy outcome (evaluated by iRECIST) were analyzed.ResultsBased on iRECIST, 32 of 120 patients showed iPD, 43 iSD, 36 iPR and 9 iCR. Multivariate analysis found that SUVmax, MTVwb, LDH and absolute platelet count were associated with treatment response (P =0.015, P =0.005, P <0.001 and P =0.015, respectively). Kaplan-Meier survival analyses showed that SUVmax ≥11.42 and LDH ≥245 U/L were associated with shorter OS (P = 0.001 and P = 0.004, respectively). Multivariate Cox regression revealed that SUVmax and LDH alone were not correlated with survival prognosis (p>0.05), but the combination of SUVmax and LDH was independently associated with OS (P=0.015, P=0.001, respectively). The median survival time (MST) for the low (LDH<245 and SUVmax<11.42), intermediate(LDH<245 or SUVmax<11.42), and high(SUVmax≥11.42 and LDH≥245) groups was 24.10 months (95% CI: 19.43 to 28.77), 17.41 months (95% CI: 15.83 to 18.99), and 13.76 months (95% CI: 12.51 to 15.02), respectively.ConclusionThis study identified that SUVmax plus LDH correlated with the survival outcome in patients with advanced lung cancer receiving PD-1/PD-L1 blockade plus chemotherapy.
Highlights
GLOBOCAN reported that lung cancer has the highest rate of incidence and mortality for men and women in the world [1]
Thirty-five (77.8%) of 45 patients were male in the Clinical benefit (CB) group, and 48 (64.0%) of 75 patients were male in the no clinical benefit (no-CB) group
It is worth mentioning that our study explored the prognostic evaluation and curative effect of SUVmax and lactate dehydrogenase (LDH) in patients treated with Immune checkpoint inhibitors (ICIs) plus chemotherapy
Summary
GLOBOCAN reported that lung cancer has the highest rate of incidence and mortality for men and women in the world [1]. It has a poor prognosis, with a 5-year survival rate of 15% [2, 3]. The 5‐year survival rate of metastatic lung cancer is no more than 5% because of the lack of appropriate treatment options. Systemic therapy has become the primary treatment option. Systemic therapy for advanced lung cancer mainly includes immunotherapy and chemotherapy, as well as their combination. Whether for non-small-cell lung cancer (NSCLC) or small cell lung cancer (SCLC), chemotherapy combined with PD-1 receptor or ligand inhibitor plays an important role in first-line therapy, and this approach has been undertaken to improve treatment responses and prolong survival [5,6,7,8,9,10,11]
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