Relationship between tumor mutational burden and maximum standardized uptake value in 2-[18F]FDG PET (positron emission tomography) scan in cancer patients

Abstract

Purpose Deriving links between imaging and genomic markers is an evolving field. 2-[18F]FDG PET/CT (18F-fluorodeoxyglucose positron emission tomography–computed tomography) is commonly used for cancer imaging, with maximum standardized uptake value (SUVmax) as the main quantitative parameter. Tumor mutational burden (TMB), the quantitative variable obtained using next-generation sequencing on a tissue biopsy sample, is a putative immunotherapy response predictor. We report the relationship between TMB and SUVmax, linking these two important parameters. Methods In this pilot study, we analyzed 1923 patients with diverse cancers and available TMB values. Overall, 273 patients met our eligibility criteria in that they had no systemic treatment prior to imaging/biopsy, and also had 2-[18F]FDG PET/CT within 6 months prior to the tissue biopsy, to ensure acceptable temporal correlation between imaging and genomic evaluation. Results We found a linear correlation between TMB and SUVmax (p < 0.001). In the multivariate analysis, only TMB independently correlated with SUVmax, whereas age, gender, and tumor organ did not. Conclusion Our observations link SUVmax in readily available, routinely used, and noninvasive 2-[18F]FDG PET/CT imaging to the TMB, which requires a tissue biopsy and time to process. Since higher TMB has been implicated as a prognostic biomarker for better outcomes after immunotherapy, further investigation will be needed to determine if SUVmax can stratify patient response to immunotherapy.

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

“…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 ). Recently, a linear positive correlation between SUVmax and tumor mutational burden (TMB), which represents one of the prognostic markers of response to immunotherapy, has been reported ( p < 0.001) [ 95 ]. These data are in line with previous findings reporting a paradoxically higher SUV in patients responding to ICI, particularly referring to NSCLC [ 66 , 70 , 96 ].…”

Positron Emission Tomography–Computed Tomography Imaging, Genomic Profile, and Survival in Patients With Head and Neck Cancer Receiving Immunotherapy

“…High SUVmax was also significantly correlated with NLR, a biomarker with both prognostic and predictive value in patients with HNSCC treated with ICI . There was no association between SUVmax and TMB, despite previous studies suggesting an association in other cancer types …”

“…3,4 There was no association between SUVmax and TMB, despite previous studies suggesting an association in other cancer types. 5 Studies examining the prognostic value of SUVmax in HNSCC have produced mixed results. In the context of ICI, we hypothesize that higher levels of systemic inflammation, of which NLR is a surrogate marker, may in part be reflected in higher lesional SUVmax.…”

Predictive value of intratumoral-metabolic heterogeneity derived from 18F-FDG PET/CT in distinguishing microsatellite instability status of colorectal carcinoma

“…TLG can reflect both volume and metabolic activity of lesions, which can reflect the advantage of PET/CT better. While SUV max , MTV, and TLG are established as parameters to assess for diagnosis, efficacy, prognosis, tumor burden, and TMB in cancer ( 32 , 33 ), they have limited value in judging IMH.…”