Combined prognostic value of the SUVmax derived from FDG-PET and the lymphocyte-monocyte ratio in patients with stage IIIB-IV non-small cell lung cancer receiving chemotherapy

Abstract

Background We evaluated the prognostic potential of tumor 18F-fluorodeoxyglucose (FDG) uptake derived from positron emission tomography (PET) and known inflammatory hematological markers, both individually and in combination, for chemosensitivity and survival in patients with stage IIIB-IV non-small cell lung cancer (NSCLC) receiving first-line chemotherapy. Methods A total of 149 patients with stage IIIB and IV NSCLC (based on TNM 7th edition) were retrospectively reviewed. Maximum standardized uptake value (SUVmax) were used to quantitatively assess FDG uptake. The lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were selected as hematological markers. Receiver operating characteristic (ROC) curves were constructed for the determination of optimal cut-off values to predict chemotherapeutic response. Results Patients with SUVmax > 11.6 or LMR ≤3.73 exhibited a significantly lower objective response rate (ORR) to chemotherapy (p < 0.001 and p < 0.001). Through multivariable logistic regression analysis, both the SUVmax and LMR were identified as independent predictive factors for chemotherapeutic response (p = 0.001 and p < 0.001). Furthermore, a multivariable Cox proportional hazard model identified a high SUVmax (> 11.6) and low LMR (≤3.73) as independent predictors of poor PFS (p < 0.001 and p = 0.025) and OS (p < 0.001 and p = 0.032). A novel score system was constructed based on the SUVmax and LMR (SUV_LMR score), and patients were stratified into three subgroups. The patients with a score of 0 had a significantly higher ORR (88.9%) than did those with a score of 1 (59.6%) and score of 2 (25.0%) (p < 0.001). Moreover, multivariable Cox analysis further identified the SUV_LMR score as an independent prognostic factor for PFS (p < 0.001) and OS (p < 0.001). Conclusions Pre-treatment SUVmax and LMR were not only predictive factors for chemotherapeutic response but also independent prognostic factors of survival in stage IIIB-IV NSCLC. Moreover, the SUV_LMR score, which is based on primary tumor metabolic activity and the systemic inflammatory response, might provide a promising tool to predict chemosensitivity, recurrence and survival of advanced NSCLC.

Role of tumor‑associated neutrophils in lung cancer (Review)

“…Furthermore, clinical studies have reported that patients with lung cancer had high levels of neutrophils in both the tumor and the circulation (26)(27)(28). The higher neutrophil/lymphocyte ratios were associated with higher recurrence rates following operations, less effective treatment responses and worse prognoses compared with the lower ratios (29)(30)(31)(32).…”

Relationship between Systemic Inflammatory Markers, GLUT1 Expression, and Maximum 18F-Fluorodeoxyglucose Uptake in Non-Small Cell Lung Carcinoma and Their Prognostic Significance

“…In one study of head and neck cancer, NLR was positively correlated with FDG-PET metabolic markers, including SUV max [ 39 ]. In NSCLC, LMR and NLR showed a weak significant correlation with SUV max [ 15 ]. In another study, SUV max and LMR were independent prognostic factors in patients with stage IIIB-IV NSCLC.…”

“…FDG-PET parameters are tumor glucose metabolic markers. Typically, the maximum standardized uptake value (SUV max ) has been associated with the progression, metastasis, and prognosis of various cancer types, including lung cancer [ 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…The clinical meaning of tumor metabolic activity and systemic inflammation in lung cancer has been extensively investigated in previous studies. However, the relationship of these key features has not been clearly elucidated, and only few studies have evaluated these hallmarks in NSCLC rather than in small-cell carcinoma [ 15 ]. Therefore, herein, we evaluated 18-F-FDG PET-CT, GLUT1 expression, NLR, PLR, and LMR, among other indicators of tumor metabolic activity and systemic inflammation, for their association with NSCLC and compared their prognostic values.…”

Prognostic Value of Intratumor Metabolic Heterogeneity Parameters on 18F‐FDG PET/CT for Patients with Colorectal Cancer

“…The 18 F-FDG PET/CT has been proven to be effective for diagnosing, staging, prognosis prediction, and treatment response assessment in numerous cancers. Conventional metabolic parameters, including metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and peak standardized uptake value (SUVmax/SUVpeak), have been proven to be effective for predicting the survival outcomes of cancer patients [ 7 – 9 ]. The concept of intratumor metabolic heterogeneity poses a challenge to patients' molecular stratification and treatment guidelines using a single tumor tissue sample [ 10 ].…”