Abstract
Objectives Immune checkpoint blockers constitute the first-line treatment for advanced non-small-cell lung cancer (NSCLC) with ≥50% PD-L1 expression. In NSCLC, PD-L1 positivity is correlated with high 18F-fluorodeoxyglucose (18F-FDG) uptake. However, these studies only included patients undergoing surgical resection, almost all in their early stages. Moreover, differences in 18F-FDG uptake between NSCLC with high (≥50%) and low (49%) PD-L1 expression remain unknown. We aimed to investigate the association between metabolic parameter 18F-FDG uptake and PD-L1 expression status in NSCLC patients. Methods From February 2017 to June 2018, 428 consecutive NSCLC patients who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) and SP142 PD-L1 expression analysis were retrospectively assessed. The association between clinicopathological characteristics and PD-L1 expression was examined. Results The frequency of PD-L1-positive tumors was 38.1% (163/428), 28.5% (91/319), and 64.2% (61/95) for NSCLC, adenocarcinoma (ADC), and squamous cell carcinoma (SCC), respectively. Maximal standard uptake (SUVmax) was significantly higher in PD-L1-positive than in PD-L1-negative NSCLC (p < 0.0001), ADC (p < 0.0001), and SCC (p=0.006). SUVmax was significantly higher in NSCLC (p=0.001) and ADC (p=0.003) with high rather than low PD-L1 expression. The receiver operating characteristic curve yielded area under the curve values of 0.726 (95% CI, 0.679–0.774, p < 0.0001), 0.694 (95% CI, 0.634–0.755, p < 0.0001), and 0.625 (95% CI, 0.513–0.738, p=0.044) for NSCLC, ADC, and SCC, respectively. Conclusion 18F-FDG tumor uptake is strongly, positively correlated with PD-L1 expression in NSCLC and significantly differs between high and low PD-L1-expressing individuals.
Highlights
During the past decades, owing to heavy smoking and air pollution, lung cancer has become the most common cancer and the leading cause of cancer death in China [1,2,3,4]. e 5year survival rate of lung cancer is 20.2%, and that of patients with advanced disease is significantly worse [5]
Positive results have been obtained in the treatment of non-small-cell lung cancer (NSCLC) [6,7,8], which have drastically revolutionized cancer therapy. e immune checkpoint status test is an effective method to identify patients who can benefit from immunotherapy
Analysis of the immune checkpoint status has become a standard of care, and tumor tissues aspirated during biopsy or intraoperatively resected are usually obtained from patients with tumors
Summary
During the past decades, owing to heavy smoking and air pollution, lung cancer has become the most common cancer and the leading cause of cancer death in China [1,2,3,4]. e 5year survival rate of lung cancer is 20.2%, and that of patients with advanced disease is significantly worse [5]. Positive results have been obtained in the treatment of non-small-cell lung cancer (NSCLC) [6,7,8], which have drastically revolutionized cancer therapy. E immune checkpoint status (programmed death ligand-1, PD-L1) test is an effective method to identify patients who can benefit from immunotherapy. PD-L1-positive patients with advanced NSCLC, patients with high PD-L1 expression, have better survival [7, 8]. Analysis of the immune checkpoint status has become a standard of care, and tumor tissues aspirated during biopsy or intraoperatively resected are usually obtained from patients with tumors. Owing to the inherent limitations of invasive procedures in patients with advanced tumors, tissues are not always readily available or may be difficult to access, resulting in sampling errors or insufficient material
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