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Background <p>The objective of this study was to investigate the prognostic significance of parameters derived from ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging in patients with advanced non-small cell lung cancer (NSCLC) receiving first-line treatment with immune checkpoint inhibitors (ICIs) and platinum-based chemotherapy, focusing on both primary tumors and metastatic sites located in the torso.</p> Methods <p>This retrospective study analyzed 70 patients diagnosed with stage III or IV NSCLC who underwent FDG PET/computed tomography (CT) prior to initiating first-line treatment with ICI–based combination therapy. Key metabolic metrics—including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)—were quantified across all detectable lesions within the torso. Associations between these PET-derived parameters and clinical outcomes, including progression-free survival (PFS) and overall survival (OS), were examined using Kaplan–Meier survival estimates and Cox proportional hazards regression.</p> Results <p>MTV-torso and TLG-torso were significantly higher in patients with poor Eastern Cooperative Oncology Group performance status (PS ≥ 2). In univariate analyses, PS, MTV-torso, and TLG-torso were significantly associated with both PFS and OS. In multivariate analyses, PS and MTV-torso remained independent predictors of both outcomes. Patients with lower MTV-torso (&lt; 225.81) had significantly higher mean PFS (582.3 vs. 154.5 days, <i>P</i> &lt; 0.001) and OS (1,047.6 vs. 291.4 days, <i>P</i> &lt; 0.001). SUVmax-torso was not significantly associated with survival.</p> Conclusions <p>Among the FDG PET-based volumetric indices, MTV-torso emerged as an independent predictor of both PFS and OS in patients with advanced NSCLC undergoing first-line treatment with ICI and platinum-based chemotherapy. These findings support the use of torso-based metabolic tumor burden assessment as a valuable tool for prognostic stratification in this patient population.</p>

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Torso FDG-PET parameters as prognostic biomarkers for advanced non-small cell lung cancer patients undergoing first-line immunotherapy and chemotherapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月30日

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  • Takafumi Obata,
  • Takashi Norikane,
  • Yuri Manabe,
  • Mitsumasa Murao,
  • Riku Morita,
  • Katsuya Mitamura,
  • Makiko Murota,
  • Yuka Yamamoto,
  • Keigo Omori,
  • Nobuhiro Kanaji,
  • Yoshihiro Nishiyama

摘要

Background

The objective of this study was to investigate the prognostic significance of parameters derived from ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging in patients with advanced non-small cell lung cancer (NSCLC) receiving first-line treatment with immune checkpoint inhibitors (ICIs) and platinum-based chemotherapy, focusing on both primary tumors and metastatic sites located in the torso.

Methods

This retrospective study analyzed 70 patients diagnosed with stage III or IV NSCLC who underwent FDG PET/computed tomography (CT) prior to initiating first-line treatment with ICI–based combination therapy. Key metabolic metrics—including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)—were quantified across all detectable lesions within the torso. Associations between these PET-derived parameters and clinical outcomes, including progression-free survival (PFS) and overall survival (OS), were examined using Kaplan–Meier survival estimates and Cox proportional hazards regression.

Results

MTV-torso and TLG-torso were significantly higher in patients with poor Eastern Cooperative Oncology Group performance status (PS ≥ 2). In univariate analyses, PS, MTV-torso, and TLG-torso were significantly associated with both PFS and OS. In multivariate analyses, PS and MTV-torso remained independent predictors of both outcomes. Patients with lower MTV-torso (< 225.81) had significantly higher mean PFS (582.3 vs. 154.5 days, P < 0.001) and OS (1,047.6 vs. 291.4 days, P < 0.001). SUVmax-torso was not significantly associated with survival.

Conclusions

Among the FDG PET-based volumetric indices, MTV-torso emerged as an independent predictor of both PFS and OS in patients with advanced NSCLC undergoing first-line treatment with ICI and platinum-based chemotherapy. These findings support the use of torso-based metabolic tumor burden assessment as a valuable tool for prognostic stratification in this patient population.