Relationship between SP142 PD-L1 Expression and ¹⁸F-FDG Uptake in Non-Small-Cell Lung Cancer

Abstract

Objectives. Immune checkpoint blockers constitute the first-line treatment for advanced non-small-cell lung cancer (NSCLC) with ≥50% PD-L1 expression. In NSCLC, PD-L1 positivity is correlated with high 18F-fluorodeoxyglucose (18F-FDG) uptake. However, these studies only included patients undergoing surgical resection, almost all in their early stages. Moreover, differences in 18F-FDG uptake between NSCLC with high (≥50%) and low (49%) PD-L1 expression remain unknown. We aimed to investigate the association between metabolic parameter 18F-FDG uptake and PD-L1 expression status in NSCLC patients. Methods. From February 2017 to June 2018, 428 consecutive NSCLC patients who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) and SP142 PD-L1 expression analysis were retrospectively assessed. The association between clinicopathological characteristics and PD-L1 expression was examined. Results. The frequency of PD-L1-positive tumors was 38.1% (163/428), 28.5% (91/319), and 64.2% (61/95) for NSCLC, adenocarcinoma (ADC), and squamous cell carcinoma (SCC), respectively. Maximal standard uptake (SUVmax) was significantly higher in PD-L1-positive than in PD-L1-negative NSCLC (p<0.0001), ADC (p<0.0001), and SCC (p=0.006). SUVmax was significantly higher in NSCLC (p=0.001) and ADC (p=0.003) with high rather than low PD-L1 expression. The receiver operating characteristic curve yielded area under the curve values of 0.726 (95% CI, 0.679–0.774, p<0.0001), 0.694 (95% CI, 0.634–0.755, p<0.0001), and 0.625 (95% CI, 0.513–0.738, p=0.044) for NSCLC, ADC, and SCC, respectively. Conclusion. 18F-FDG tumor uptake is strongly, positively correlated with PD-L1 expression in NSCLC and significantly differs between high and low PD-L1-expressing individuals.

Correlation of epidermal growth factor receptor mutation status and PD-L1 expression with [18F]FDG PET using volume-based parameters in non-small cell lung cancer

“…The SUVmax in patients with PD-L1 expression (TPS ≥ 5%) was significantly higher than that without PD-L1 expression in NSCLC [8]. Zhao et al also demonstrated that SUVmax was higher in the high PD-L1 expression group (TPS ≥ 50%) than in the low PD-L1 expression group (TPS: 1-49%) in NSCLC [9]. In contrast, Lopci et al found no significant association between PD-L1 expression level and SUVmax in NSCLC [16].…”

“…PD-L1 TPS <1%, 1-49%, and ≥50% were considered to be negative PD-L1 expression, low PD-L1 expression, and high PD-L1 expression, respectively [9,17]. The patients were divided into six groups based on their EGFR mutation status and PD-L1 expression level, that is, EGFR-mutated and negative PD-L1 expression (EGFR mutant/negative PD-L1), low PD-L1 expression (EGFR mutant/low PD-L1), and high PD-L1 expression (EGFR mutant/high PD-L1), and wild-type EGFR and negative PD-L1 expression (EGFR wild/negative PD-L1), low PD-L1 expression (EGFR wild/low PD-L1), and high PD-L1 expression (EGFR wild/high PD-L1) groups.…”

“…PET with 2-deoxy-2-[ 18 F]fluoro-D-glucose (FDG) is a useful molecular imaging modality for staging, restaging, and assessment of the therapeutic response of NSCLC [5]. More recently, several studies have been focusing on the association between FDG PET and EGFR mutation status or PD-L1 expression level [6][7][8][9][10][11][12][13][14][15][16][17], but the results have been inconsistent, and so the relationship has yet to be firmly established. The most commonly used PET semiquantitative parameter is a standardized uptake value (SUV).…”

PET/CT molecular imaging in the era of immune-checkpoint inhibitors therapy

“…The majority of researches on the application of 18 F-FDG PET/CT imaging on TIME characterization focused on nonsmall-cell lung cancer (NSCLC) (Table 1). Zhao et al carried out two studies with the largest sample sizes (419 cases and 428 cases) to investigate the relationship between PD-L1 expression and 18 F-FDG uptake, using 22C3 and SP142 assays, respectively (19,20). They both showed that maximum standardized uptake value (SUVmax) was significantly associated with PD-L1 expression in NSCLC.…”

Molecular Imaging and the PD-L1 Pathway: From Bench to Clinic

“…A metabolic score derived from combined assessment of pretreatment MTV and the neutrophil-to-lymphocyte ratio may provide a more accurate prediction of outcome than either of these factors alone (47,48). Furthermore, in patients with NSCLC, the maximal standard uptake value (SUV) of 18 F-FDG has been reported to be positively associated with PD-L1 expression (49,50), and high 18 F-FDG MTV is associated with PD-L1 expression ≥75% (48). However, 18 F-FDG PET imaging, like computed tomography (CT), can show pseudoprogression (an early increase in tumor volume and FDG uptake on imaging with a subsequent favorable response to ICI therapy) (51,52).…”