目的:化学免疫疗法,包括程序性死亡配体1(PD-L1)抗体,是广泛期小细胞肺癌(ES-SCLC)患者的有效治疗方法。然而,尚未建立用于预测化学免疫疗法的生物标志物。因此,我们研究了18F-氟代脱氧葡萄糖(FDG)-正电子发射断层扫描(PET)作为预测标志物的潜力。
方法:46例ES-SCLC患者在以铂类为基础的化疗联合PD-L1阻断作为一线治疗之前立即接受了18F-FDG-PET,和最大标准吸收值(SUVmax),代谢性肿瘤体积(MTV),评估18F-FDG摄取的总病变糖酵解(TLG)。
结果:对46例患者中的36例进行了PD-L1和肿瘤浸润淋巴细胞(TIL)的免疫组织化学分析。高MTV与不良表现状态和低白蛋白水平显着相关,低白蛋白和高TLG之间存在显著关联。单变量分析确定性别,布林克曼指数,和MTV作为无进展生存期(PFS)的重要预测因子,和性,SUVmax,MTV,TLG是总生存期(OS)的重要因素。多变量分析表明,性别,布林克曼指数,MTV是影响PFS的独立预后因素,和性,SUVmax,MTV,和TLG是OS的重要预测因子。PD-L1表达阳性的患者的SUVmax明显高于表达阴性的患者,但阳性和阴性TIL之间没有显着差异。此外,MTV和TLG水平与PD-L1和TILs水平无关。
结论:MTV或TLG代谢性肿瘤活性适用于预测ES-SCLC患者的化疗-免疫治疗结果。
OBJECTIVE: Chemo-immunotherapy, including the programmed death ligand 1 (PD-L1) antibody, is an effective treatment for patients with extensive-stage small-cell lung cancer (ES-SCLC). However, no biomarker has been established for the prediction of chemo-immunotherapy. Therefore, we investigated the potential of 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) as a predictive marker.
METHODS: Forty-six patients with ES-SCLC who received 18F-FDG-PET immediately before combined platinum-based chemotherapy with PD-L1 blockade as a first-line treatment were eligible, and the maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on 18F-FDG uptake were evaluated.
RESULTS: PD-L1 and tumor infiltrative lymphocytes (TILs) were immunohistochemically analyzed in 36 of the 46 patients. A high MTV was significantly associated with poor performance status and low albumin levels, and there was a significant association between low albumin and high TLG. Univariate analysis identified sex, Brinkman index, and MTV as significant predictors of progression-free survival (PFS), and sex, SUVmax, MTV, and TLG as significant factors of overall survival (OS). Multivariate analysis revealed that sex, Brinkman index, and MTV were independent prognostic factors for PFS, and sex, SUVmax, MTV, and TLG were significant predictors of OS. SUVmax was significantly higher in patients with positive PD-L1 expression than in those with negative expression but was not significantly different between positive and negative TILs. Moreover, the levels of MTV and TLG were not closely associated with the levels of PD-L1 and TILs.
CONCLUSIONS: MTV or TLG metabolic tumor activity is suitable for the prediction of chemo-immunotherapy outcomes in patients with ES-SCLC.