Prognostic Significance of SUVmax Combined With Lactate Dehydrogenase in Advanced Lung Cancer Patients Treated With Immune Checkpoint Inhibitor Plus Chemotherapy: A Retrospective Study

Abstract

PurposeThis research aims to investigate the predictive capacity of PET/CT quantitative parameters combined with haematological parameters in advanced lung cancer patients treated with immune checkpoint inhibitor (ICI) plus chemotherapy.MethodsA total of 120 patients who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) were enrolled before therapy. The following parameters were calculated: the maximum, mean, and peak standardized uptake value (SUVmax, SUVmean, and SUVpeak, respectively); total tumour volume (MTV) and total lesion glycolysis (TLG); and whole-body metabolic values (MTVwb, TLGwb, SUVmeanwb, and SUVmaxwb). Lactate dehydrogenase (LDH) levels, absolute neutrophil count, absolute platelet count, albumin levels and derived neutrophil to lymphocyte ratio (dNLR) were also computed. The associations between the variables and therapy outcome (evaluated by iRECIST) were analyzed.ResultsBased on iRECIST, 32 of 120 patients showed iPD, 43 iSD, 36 iPR and 9 iCR. Multivariate analysis found that SUVmax, MTVwb, LDH and absolute platelet count were associated with treatment response (P =0.015, P =0.005, P <0.001 and P =0.015, respectively). Kaplan-Meier survival analyses showed that SUVmax ≥11.42 and LDH ≥245 U/L were associated with shorter OS (P = 0.001 and P = 0.004, respectively). Multivariate Cox regression revealed that SUVmax and LDH alone were not correlated with survival prognosis (p>0.05), but the combination of SUVmax and LDH was independently associated with OS (P=0.015, P=0.001, respectively). The median survival time (MST) for the low (LDH<245 and SUVmax<11.42), intermediate(LDH<245 or SUVmax<11.42), and high(SUVmax≥11.42 and LDH≥245) groups was 24.10 months (95% CI: 19.43 to 28.77), 17.41 months (95% CI: 15.83 to 18.99), and 13.76 months (95% CI: 12.51 to 15.02), respectively.ConclusionThis study identified that SUVmax plus LDH correlated with the survival outcome in patients with advanced lung cancer receiving PD-1/PD-L1 blockade plus chemotherapy.

Immunotherapy Monitoring with Immune Checkpoint Inhibitors Based on [18F]FDG PET/CT in Metastatic Melanomas and Lung Cancer

“…To date, special attention has been given to other parameters obtainable from [ 18 F]FDG PET/CT during ICI. Not just standardized uptake value (SUV), but also metabolic tumor volume (MTV) and total lesion glycolysis (TLG), have been investigated at baseline and during treatment as absolute values or as variations to predict response and outcome [ 28 , 47 , 51 , 53 , 54 , 55 , 56 , 58 , 59 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 76 , 77 , 78 , 79 , 82 , 83 , 86 , 87 , 88 ]. While SUV appears to be inversely correlated to response to ICI [ 66 , 70 , 80 ] with higher SUV values being in some reports indicative of treatment benefit, on the other hand higher MTV and TLG values result in negative predictive factors for patient outcome during ICI ( Table 2 ).…”

“…In particular, circulating inflammatory markers, such as neutrophyl-to-lymphocyte ratio (NLR) and its derived value (dNLR) have proved to better stratify patients undergoing immunotherapy with ICI into risk groups (i.e., higher values predicting poor outcome), both at baseline and after treatment start [ 71 , 72 , 76 , 80 ]. Similarly, the combination of volumetric parameters on PET with circulating tumor cells (CTC) count and soluble PD-L1 [ 72 , 75 , 83 ], or lactate dehydrogenase (LDH) [ 88 ] has been reported to be as useful for risk stratification. Thanks to the capability of [ 18 F]FDG PET/CT to depict underlying immunological status, expressed as bone marrow or lymphatic organ activation (i.e., bone marrow-to-liver ratio, spleen-to-liver ratio) or by the development of irAEs, it is also possible to combine metabolic and immunological parameters to improve response prediction and outcome [ 48 , 49 , 50 , 51 , 52 , 53 , 56 , 57 , 81 ].…”

The Prognostic Value of Gastric Immune Prognostic Index in Gastric Cancer Patients Treated With PD-1/PD-L1 Inhibitors

“…The increase in LDH level is the product of tumor glycolytic activity and tumor necrosis caused by hypoxia, and the latter is related to the high tumor burden ( Van Wilpe et al, 2020 ). The LDH levels are inversely associated with response to checkpoint inhibitors and glycolysis inhibitors ( Laganá et al, 2019 ; Ke et al, 2021 ).…”

The Association Between Albumin Levels and Survival in Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis

“…More than half of the studies were reported from Far East (n = 15) [32, 39-52], followed by Europe (n = 12) [25,31,37,38,[53][54][55][56][57][58][59][60]]. The 3.5 gr/dL was the most frequently used albumin cut-off in the included studies (n = 20) [25, 31-33, 37, 38, 40-43, 45-52, 54, 56-64], while eight studies evaluated the effect of albumin levels on survival by using albumin as a continuous measure [34,39,44,53,55,[65][66][67]. All but two studies reported HR for OS [25,36,49], while data for PFS was available in the 15 studies [25, 32, 33, 36, 40-42, 48-50, 52, 53, 57, 60, 63, 66].…”

“…The important portion of the heterogeneity were stemmed from the studies including the albumin as a continuous parameter in the analyses. After the exclusion of these studies (n=8) [34,39,44,53,55,[65][66][67], the heterogeneity was decreased to 45% and xed effect meta-analysis after the exclusion of these studies demonstrated a consistent negative effect of low albumin levels on OS (HR: 2.17, 95% CI: 2.00-2.36, p<0.0001) (Figure S2). Sensitivity analyses with the exclusion of individual studies were also demonstrated signi cantly higher risk of death in patients with lower albumin levels.…”