Abstract
Purpose: Immunotherapy has been successfully utilized for treatment of gastric cancer, so the identification of clinicopathologic features that are predictive of response to this therapy is crucial. 18F-FDG PET/CT can provide information on the molecular phenotype of many malignant tumors. The correlation between 18F-FDG accumulation and PD-L1/PD-L1-TILs status in gastric cancer patients has not been investigated. The aim of the current study is to assess whether 18F-FDG accumulation is associated with PD-L1/PD-L1-TILs status, and whether 18F-FDG PET/CT may be useful for predicting PD-L1/PD-L1-TILs expression of gastric cancer.Results: Tumors with positive PD-L1 expression had higher SUVmax than in tumors with negative PD-L1 expression (15.0 ± 8.0 vs. 7.2 ± 4.2, respectively; P = 0.004). Tumors with positive PD-L1-TILs expression also had higher SUVmax than in tumors with negative PD-L1-TILs expression (10.3 ± 6.5 vs. 6.6 ± 3.7, respectively; P = 0.034). Multivariate analysis suggested that SUVmax remained significantly correlated with the status of PD-L1 (P = 0.043) and PD-L1-TILs (P = 0.016). PD-L1 expression was predicted with an accuracy of 67.2% when a SUVmax value of 8.55 was used as a cutoff point for analysis. Similarly, PD-L1-TILs expression was predicted with an accuracy of 64.2%, when a SUVmax value of 7.9 was used as the threshold for analysis.Conclusion: Higher 18F-FDG accumulation in gastric cancers is correlated with positive PD-L1/PD-L1-TILs expression. 18F-FDG PET/CT may be used to predict the status of PD-L1/PD-L1-TILs and thus aid in optimal treatment decision.Methods: A retrospective analysis was conducted on 64 patients with gastric cancer who underwent 18F-FDG PET/CT. SUVmax was calculated from the 18F-FDG accumulation of the primary tumor. The relationship between SUVmax and PD-L1/PD-L1-TILs status was analyzed.
Highlights
Gastric cancer is the fifth most frequent malignant tumors worldwide [1]
Despite the use of Trastuzumab for patients with positive HER2 expression and targeting VEGFR2 leading to improved survival [2,3,4], there is still a considerable number of patients who are unresponsive to treatment
Detecting PD-L1 expression is common in the management of gastric cancer. 18F-FDG PET/CT is a noninvasive diagnostic tool to detect malignant tumors
Summary
Gastric cancer is the fifth most frequent malignant tumors worldwide [1]. Gastric cancer patients are often diagnosed with inoperable or metastatic disease, and treatment outcomes for such patients remain poor. Immunotherapy with anti-PD-L1 blocker is seen as an effective therapeutic approach for www.aging-us.com many malignant tumors. Pembrolizumab was approved to use in gastric cancer patients with metastatic or recurrent locally lesions and high PD-L1 expression in the USA [7]. Teng MW et al showed that TIL positive/PD-L1 positive pattern and TIL positive/PD-L1 negative pattern can be regarded as "Hot tumor" which can expect therapeutic effect from PD-1 targeted therapy combined with or without another chemotherapy [9]. It is meaningful to identify useful clinicopathologic feature in gastric cancer patients to predict PD-L1 expression. There are no validated clinicopathologic characteristics to select a priori patients who may benefit from immunotherapy in gastric cancer
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