Metabolic Tumor Volume Measured by 18F-FDG PET/CT is Associated with the Survival of Unresectable Hepatocellular Carcinoma Treated with PD-1/PD-L1 Inhibitors Plus Molecular Targeted Agents

Abstract

Purpose The combination of PD-1/PD-L1 inhibitors and molecular targeted agents showed promising efficacy for unresectable hepatocellular carcinoma (uHCC). This study aimed to investigate the prognostic value of metabolic parameters from 18 F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET/CT) in patients with uHCC underwent the combined therapies. Patients and Methods Patients with uHCC treated with a combination of immunotherapy and targeted therapy who underwent baseline 18 F-FDG PET/CT between July 2018 and December 2021 were recruited retrospectively. The metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake values (SUV max ), and clinical and biological parameters were recorded. A multivariate prediction model was developed for overall survival (OS) using these parameters together with clinical prognostic factors. Results Seventy-seven patients were finally included. The median OS was 16.8 months. We found that a high MTV (≥39.65 cm 3 as the median value) was significantly associated with OS (P<0.05). In multivariate analyses for OS, a high MTV, high Eastern Cooperative Oncology Group performance status (ECOG-PS, ≥1), Child-Pugh (B-C) grade, and the presence of bone metastasis were significantly associated with poor OS (HR 1.371, HR 3.73, HR 15.384, and HR 2.994, all P<0.05, respectively). A multivariate prognostic model including MTV and prognostic factors, such as ECOG-PS, Child-Pugh grade, and bone metastasis, further improved the identification of different OS subgroups. Conclusion High MTV is an adverse prognostic factor in patients with uHCC treated with a combination of immunotherapy and molecular targeted agents. Integrating PET/CT parameters with clinical prognostic factors could help to personalize immunotherapy.

Biomarkers and prognostic factors of PD-1/PD-L1 inhibitor-based therapy in patients with advanced hepatocellular carcinoma

“…Evidence suggests that 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/CT can predict the prognosis of individuals who received immunotherapy combined with molecular targeted drugs. Wang et al found that total lesion glycolysis was associated with the outcomes of immunotherapy [ 71 ], while another study found that Metabolic Tumor Volume was a more promising parameter to forecast immunotherapy effectiveness [ 72 ]. A predictive model constructed by combining clinical parameters (ECOG score, Child-Pugh score, and bone metastasis situation) was able to effectively distinguish patients based on their treatment benefit [ 72 ].…”

“…Wang et al found that total lesion glycolysis was associated with the outcomes of immunotherapy [ 71 ], while another study found that Metabolic Tumor Volume was a more promising parameter to forecast immunotherapy effectiveness [ 72 ]. A predictive model constructed by combining clinical parameters (ECOG score, Child-Pugh score, and bone metastasis situation) was able to effectively distinguish patients based on their treatment benefit [ 72 ]. Additionally, dual-tracer development has attracted attention, with 11 C-acetate and 18 F-FDG PET/CT exhibiting the potential to differentiate those who are prone to benefit from TKIs or immunotherapy [ 73 ].…”

Cancer Immunotherapy and Medical Imaging Research Trends from 2003 to 2023: A Bibliometric Analysis

“…Currently, the efficacy and adverse events of tumor immunotherapy can be preliminarily assessed through imaging studies. [9][10][11] It is also possible to establish image-based biomarkers 12,13 or efficacy prediction models combined with clinical characteristics to screen the appropriate population for immunotherapy and implement personalized treatment. 14,15 Clinically, it is routine to use various medical image-based efficacy evaluation standards for solid tumors to assess treatment efficacy.…”