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Background <p>This study aimed to investigate whether PD-1 antibody therapy modulates brown adipose tissue (BAT) activity and whether BAT activation is associated with cardiovascular risk parameters in cancer patients.</p> Methods design <p>Retrospective cohort study.</p> Setting <p>Two tertiary hospitals in Fujian Province, China (Fujian Provincial Hospital and Fujian Cancer Hospital), between January 2019 and January 2024.</p> Participants <p>Sixty-eight cancer patients (54 males, 14 females) who received PD-1 antibody therapy (e.g., pembrolizumab, 200&#xa0;mg Q3W) and underwent paired <sup>18</sup>F-FDG PET/CT scans (pre-treatment and post-treatment, median interval: 3.2&#xa0;months). Exclusion criteria: hypothyroidism (<i>n</i> = 3), severe renal insufficiency (<i>n</i> = 2), and incomplete PET/CT or laboratory data. Outcome measures: primary outcome: change in BAT activity (quantified by supraclavicular fossa SUVmax via PET/CT) pre- versus post-PD-1 therapy. Secondary outcomes: changes in VAT/SAT SUVmax, lipid profiles (triglycerides [TG], total cholesterol [TC], LDL-C, and HDL-C), arterial stiffness index (ASI), cardiac biomarkers (cTnT and NT-proBNP), and thyroid function (TSH, FT3, FT4).</p> Results <p>Following immunotherapy, BAT SUV<sub>max</sub> exhibited a marked increase of 68.0%, whereas visceral and subcutaneous fat SUV<sub>max</sub> rose by 29.6% and 30.8%, respectively (<i>P</i> &lt; 0.001 for all). Significant dyslipidemia was observed post-treatment (<i>P</i> &lt; 0.05): arterial stiffness index (ASI) increased by 17.0%, triglycerides by 22.6%, total cholesterol by 9.6%, and LDL-C by 9.7%. Notably, partial correlation analysis revealed an inverse relationship between BAT activity and ASI (<i>r</i> = − 0.321, <i>P</i> = 0.011). Multivariate linear regression identified ASI (<i>β</i> = − 1.208, <i>P</i> = 0.009) and high-density lipoprotein (<i>β</i> = − 1.074, <i>P</i> = 0.038) as independent predictors of BAT activity.</p> Conclusions <p>PD-1 antibodies enhance BAT activity in cancer patients, and higher BAT activity is associated with reduced arterial stiffness. PET/CT-derived BAT SUVmax may serve as a novel biomarker for cardiovascular risk stratification during PD-1 antibody therapy.</p>

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Brown adipose tissue activation and cardiovascular risk following PD-1 antibody therapy in cancer patients: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2025年11月28日

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  • Bingqian Lin,
  • Duanyu Lin,
  • Xiaodan Ou,
  • Jinwen Wang,
  • Shun Yu,
  • Gan Chen,
  • Junping Wen

摘要

Background

This study aimed to investigate whether PD-1 antibody therapy modulates brown adipose tissue (BAT) activity and whether BAT activation is associated with cardiovascular risk parameters in cancer patients.

Methods design

Retrospective cohort study.

Setting

Two tertiary hospitals in Fujian Province, China (Fujian Provincial Hospital and Fujian Cancer Hospital), between January 2019 and January 2024.

Participants

Sixty-eight cancer patients (54 males, 14 females) who received PD-1 antibody therapy (e.g., pembrolizumab, 200 mg Q3W) and underwent paired 18F-FDG PET/CT scans (pre-treatment and post-treatment, median interval: 3.2 months). Exclusion criteria: hypothyroidism (n = 3), severe renal insufficiency (n = 2), and incomplete PET/CT or laboratory data. Outcome measures: primary outcome: change in BAT activity (quantified by supraclavicular fossa SUVmax via PET/CT) pre- versus post-PD-1 therapy. Secondary outcomes: changes in VAT/SAT SUVmax, lipid profiles (triglycerides [TG], total cholesterol [TC], LDL-C, and HDL-C), arterial stiffness index (ASI), cardiac biomarkers (cTnT and NT-proBNP), and thyroid function (TSH, FT3, FT4).

Results

Following immunotherapy, BAT SUVmax exhibited a marked increase of 68.0%, whereas visceral and subcutaneous fat SUVmax rose by 29.6% and 30.8%, respectively (P < 0.001 for all). Significant dyslipidemia was observed post-treatment (P < 0.05): arterial stiffness index (ASI) increased by 17.0%, triglycerides by 22.6%, total cholesterol by 9.6%, and LDL-C by 9.7%. Notably, partial correlation analysis revealed an inverse relationship between BAT activity and ASI (r = − 0.321, P = 0.011). Multivariate linear regression identified ASI (β = − 1.208, P = 0.009) and high-density lipoprotein (β = − 1.074, P = 0.038) as independent predictors of BAT activity.

Conclusions

PD-1 antibodies enhance BAT activity in cancer patients, and higher BAT activity is associated with reduced arterial stiffness. PET/CT-derived BAT SUVmax may serve as a novel biomarker for cardiovascular risk stratification during PD-1 antibody therapy.