Relationship between SUVmax in <sup>18</sup>F-FDG PET/CT and PD-L1 expression in invasive lung adenocarcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Daxin ¹ , HUANG Wenxia ² ,  HUANG Xiaoli ¹ , HE Fuqian ¹ , SU Minggang ³ , JIANG Yong ⁴

1. Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Equipment and Materials, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
3. Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
4. Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

Keywords：

Invasive lung adenocarcinoma; ¹⁸F-FDG PET/CT; SUVmax; PD-L1; clinical factors

DOI：

10.7507/1007-4848.201908023

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the relationship between the expression of programmed cell death ligand-1 (PD-L1) and the maximal standardized uptake value (SUVmax) in ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the correlation of clinical factors between SUVmax values and PD-L1.Methods The clinical data of 84 patients with invasive lung adenocarcinoma diagnosed pathologically in West China Hospital, Sichuan University from August 2016 to November 2018 were analyzed retrospectively, including 38 males and 46 females, aged 60 (32-85) years. The tumor was acinar-predominant in 37 patients, papillary in 20, lepidic in 19, solid in 5 and micropapillary in 3. Multivariate analysis of the relationship between SUVmax value and other clinicopathological features was performed by linear regression. Logistic regression analysis was used to analyze the relationship between PD-L1 protein expression and other pathological features.Results The SUVmax of the PD-L1 expression group was significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group (P=0.002) and intermediate-grade histologic subtype (P=0.016). The SUVmax cut-off value of PD-L1 expression in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype was 5.34 (AUC: 0.732, P=0.002) and 5.34 (AUC: 0.720, P=0.017), respectively. Multivariate analysis showed that pleura involvement, vascular tumor thrombus and the increase of tumor diameter could cause the increase of the SUVmax value, while the SUVmax value decreased in the moderately differentiated tumor compared with the poorly differentiated tumor. The SUVmax cut-off value between low-grade histologic subtype and intermediate-grade histologic subtype, intermediate-grade histologic subtype and high-grade histologic subtypes was 1.54 (AUC: 0.854, P<0.001) and 5.79 (AUC: 0.889, P<0.001), respectively. Multivariate analysis of PD-L1 expression showed pleura involvement (P=0.021, OR=0.022, 95%CI 0.001 to 0.558) and moderate differentiation (opposite to poor differentiation) (P=0.004, OR=0.053, 95%CI 0.007 to 0.042) decreased the expression of PD-L1.Conclusion The SUVmax of the PD-L1 expression group is significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype. The level of SUVmax and the expression of PD-L1 in invasive lung adenocarcinoma are related to many clinical factors.

Citation： GUO Daxin, HUANG Wenxia, HUANG Xiaoli, HE Fuqian, SU Minggang, JIANG Yong. Relationship between SUVmax in ¹⁸F-FDG PET/CT and PD-L1 expression in invasive lung adenocarcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(3): 290-296. doi: 10.7507/1007-4848.201908023 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	Reck M, Rodríguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med, 2016, 375(19): 1823-1833.
3.	Mok TSK, Wu YL, Kudaba I, et al. Pembrolizumab versus chemotherapy for previously untreated, PD-L1-expressing, locally advanced or metastatic non-small-cell lung cancer (KEYNOTE-042): a randomised, open-label, controlled, phase 3 trial. Lancet, 2019, 393(10183): 1819-1830.
4.	Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet, 2017, 389(10066): 255-265.
5.	孫濤, 韓善清, 汪家旺. PET/CT 成像原理、優勢及臨床應用. 中國醫學物理學雜志, 2010, 27(1): 1581-1582, 1587.
6.	楊欣, 林冬梅. 2015 版 WHO 肺癌組織學分類變化及其臨床意義. 中國肺癌雜志, 2016, 19(6): 332-336.
7.	Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer, 2012, 12(4): 252-264.
8.	Soria JC, Marabelle A, Brahmer JR, et al. Immune checkpoint modulation for non-small cell lung cancer. Clin Cancer Res, 2015, 21(10): 2256-2262.
9.	Wu YL, Lu S, Cheng Y, et al. Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced NSCLC: CheckMate 078 randomized phase Ⅲ clinical trial. J Thorac Oncol, 2019, 14(5): 867-875.
10.	Daskivich TJ, Belldegrun A. Words of wisdom. Re: Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. Eur Urol, 2015, 67(4): 816-817.
11.	Takada K, Toyokawa G, Tagawa T, et al. Association between PD-L1 expression and metabolic activity on ¹⁸F-FDG PET/CT in patients with small-sized lung cancer. Anticancer Res, 2017, 37(12): 7073-7082.
12.	Takada K, Toyokawa G, Okamoto T, et al. Metabolic characteristics of programmed cell death-ligand 1-expressing lung cancer on ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography. Cancer Med, 2017, 6(11): 2552-2561.
13.	Kaira K, Shimizu K, Kitahara S, et al. 2-Deoxy-2-[fluorine-18] fluoro-d-glucose uptake on positron emission tomography is associated with programmed death ligand-1 expression in patients with pulmonary adenocarcinoma. Eur J Cancer, 2018, 101: 181-190.
14.	林冬梅. 中國非小細胞肺癌 PD-L1 檢測現狀. 中華病理學雜志, 2017, 46(10): 665-668.
15.	Scheel AH, Dietel M, Heukamp LC, et al. Harmonized PD-L1 immunohistochemistry for pulmonary squamous-cell and adenocarcinomas. Mod Pathol, 2016, 29(10): 1165-1172.
16.	趙寧, 任紅亮, 潘娜, 等. 非小細胞肺癌組織 PD-L1 的表達及其與臨床因素的關系. 中國腫瘤生物治療雜志, 2017, 24(3): 284-289.
17.	黨亞萍, 劉剛, 王紅, 等. PET/CT 對肺內結節診斷及治療的臨床價值. 中華腫瘤雜志, 2004, 26(11): 685-687.
18.	Erasmus JJ, Rohren E, Swisher SG. Prognosis and reevaluation of lung cancer by positron emission tomography imaging. Proc Am Thorac Soc, 2009, 6(2): 171-179.
19.	Yoshida T, Tanaka H, Kuroda H, et al. Standardized uptake value on (18)F-FDG-PET/CT is a predictor of EGFR T790M mutation status in patients with acquired resistance to EGFR-TKIs. Lung Cancer, 2016, 100: 14-19.
20.	杜海磊, 車嘉銘, 朱良綱, 等. 病理 T1 期浸潤性肺腺癌不同病理亞型的臨床特征及其預后分析. 診斷學理論與實踐, 2018, 17(1): 82-86.
21.	Yoshida Y, Nitadori JI, Shinozaki-Ushiku A, et al. Micropapillary histological subtype in lung adenocarcinoma of 2 cm or less: impact on recurrence and clinical predictors. Gen Thorac Cardiovasc Surg, 2017, 65(5): 273-279.
22.	Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol, 2009, 27(17): 2758-2765.
23.	Park B, Lee G, Kim HK, et al. A retrospective comparative analysis of elderly and younger patients undergoing pulmonary resection for stage Ⅰ non-small cell lung cancer. World J Surg Oncol, 2016, 14(1): 13.
24.	Nosaki K, Saka H, Hosomi Y, et al. Safety and efficacy of pembrolizumab monotherapy in elderly patients with PD-L1-positive advanced non-small-cell lung cancer: Pooled analysis from the KEYNOTE-010, KEYNOTE-024, and KEYNOTE-042 studies. Lung Cancer, 2019, 135: 188-195.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Reck M, Rodríguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med, 2016, 375(19): 1823-1833.
3. Mok TSK, Wu YL, Kudaba I, et al. Pembrolizumab versus chemotherapy for previously untreated, PD-L1-expressing, locally advanced or metastatic non-small-cell lung cancer (KEYNOTE-042): a randomised, open-label, controlled, phase 3 trial. Lancet, 2019, 393(10183): 1819-1830.
4. Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet, 2017, 389(10066): 255-265.
5. 孫濤, 韓善清, 汪家旺. PET/CT 成像原理、優勢及臨床應用. 中國醫學物理學雜志, 2010, 27(1): 1581-1582, 1587.
6. 楊欣, 林冬梅. 2015 版 WHO 肺癌組織學分類變化及其臨床意義. 中國肺癌雜志, 2016, 19(6): 332-336.
7. Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer, 2012, 12(4): 252-264.
8. Soria JC, Marabelle A, Brahmer JR, et al. Immune checkpoint modulation for non-small cell lung cancer. Clin Cancer Res, 2015, 21(10): 2256-2262.
9. Wu YL, Lu S, Cheng Y, et al. Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced NSCLC: CheckMate 078 randomized phase Ⅲ clinical trial. J Thorac Oncol, 2019, 14(5): 867-875.
10. Daskivich TJ, Belldegrun A. Words of wisdom. Re: Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. Eur Urol, 2015, 67(4): 816-817.
11. Takada K, Toyokawa G, Tagawa T, et al. Association between PD-L1 expression and metabolic activity on ¹⁸F-FDG PET/CT in patients with small-sized lung cancer. Anticancer Res, 2017, 37(12): 7073-7082.
12. Takada K, Toyokawa G, Okamoto T, et al. Metabolic characteristics of programmed cell death-ligand 1-expressing lung cancer on ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography. Cancer Med, 2017, 6(11): 2552-2561.
13. Kaira K, Shimizu K, Kitahara S, et al. 2-Deoxy-2-[fluorine-18] fluoro-d-glucose uptake on positron emission tomography is associated with programmed death ligand-1 expression in patients with pulmonary adenocarcinoma. Eur J Cancer, 2018, 101: 181-190.
14. 林冬梅. 中國非小細胞肺癌 PD-L1 檢測現狀. 中華病理學雜志, 2017, 46(10): 665-668.
15. Scheel AH, Dietel M, Heukamp LC, et al. Harmonized PD-L1 immunohistochemistry for pulmonary squamous-cell and adenocarcinomas. Mod Pathol, 2016, 29(10): 1165-1172.
16. 趙寧, 任紅亮, 潘娜, 等. 非小細胞肺癌組織 PD-L1 的表達及其與臨床因素的關系. 中國腫瘤生物治療雜志, 2017, 24(3): 284-289.
17. 黨亞萍, 劉剛, 王紅, 等. PET/CT 對肺內結節診斷及治療的臨床價值. 中華腫瘤雜志, 2004, 26(11): 685-687.
18. Erasmus JJ, Rohren E, Swisher SG. Prognosis and reevaluation of lung cancer by positron emission tomography imaging. Proc Am Thorac Soc, 2009, 6(2): 171-179.
19. Yoshida T, Tanaka H, Kuroda H, et al. Standardized uptake value on (18)F-FDG-PET/CT is a predictor of EGFR T790M mutation status in patients with acquired resistance to EGFR-TKIs. Lung Cancer, 2016, 100: 14-19.
20. 杜海磊, 車嘉銘, 朱良綱, 等. 病理 T1 期浸潤性肺腺癌不同病理亞型的臨床特征及其預后分析. 診斷學理論與實踐, 2018, 17(1): 82-86.
21. Yoshida Y, Nitadori JI, Shinozaki-Ushiku A, et al. Micropapillary histological subtype in lung adenocarcinoma of 2 cm or less: impact on recurrence and clinical predictors. Gen Thorac Cardiovasc Surg, 2017, 65(5): 273-279.
22. Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol, 2009, 27(17): 2758-2765.
23. Park B, Lee G, Kim HK, et al. A retrospective comparative analysis of elderly and younger patients undergoing pulmonary resection for stage Ⅰ non-small cell lung cancer. World J Surg Oncol, 2016, 14(1): 13.
24. Nosaki K, Saka H, Hosomi Y, et al. Safety and efficacy of pembrolizumab monotherapy in elderly patients with PD-L1-positive advanced non-small-cell lung cancer: Pooled analysis from the KEYNOTE-010, KEYNOTE-024, and KEYNOTE-042 studies. Lung Cancer, 2019, 135: 188-195.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between SUVmax in ¹⁸F-FDG PET/CT and PD-L1 expression in invasive lung adenocarcinoma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between SUVmax in 18F-FDG PET/CT and PD-L1 expression in invasive lung adenocarcinoma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content

Relationship between SUVmax in ¹⁸F-FDG PET/CT and PD-L1 expression in invasive lung adenocarcinoma