Frontiers in oncology · 2026
Baseline 18F-FDG PET/CT metabolic parameters and systemic inflammatory markers in advanced NSCLC treated with first-line immunotherapy: an exploratory retrospective analysis.
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Resuli Blerina, Walter Julia, Völter Friederike, Kauffmann-Guerrero Diego, Dahlmann Paul, Hirner Raphael, Unterrainer Lena, Mertsch Pontus, Arnold Paola, Mras Paula, Leuschner Gabriela, Rübenthaler Johannes, Schneider Christian, Behr Jürgen, Tufman Amanda
Аннотация
BACKGROUND: Predictive biomarkers for patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) remain limited. Systemic inflammation plays a crucial role in cancer progression and immune regulation. We evaluated whether baseline 18F-FDG PET/CT metabolic parameters and systemic inflammatory markers are associated with treatment response and survival in patients with advanced NSCLC treated with first-line ICIs.
METHODS: Among 142 patients treated with first-line ICIs either as monotherapy or combined with chemotherapy, between October 2018 and December 2023, 116 had baseline PET/CT imaging. Quantitative analyses of standardized uptake value max (SUVmax) and metabolic tumor volume (MTV) were restricted to 71 patients whose scans were performed at our institution. Associations with response, progression free survival (PFS), and overall survival (OS) were analyzed.
RESULTS: In multivariable models including clinical variables, PET biomarkers and inflammatory markers, no individual PET or inflammatory biomarker remained independently associated with survival. Combined models suggested better prognostic discrimination compared with PET-only or inflammation-only models (OS C-index 0.745; PFS C-index 0.750). In contrast, sex, TTF-1 status, and the presence of adrenal and lung metastases emerged as independent predictors of OS and/or PFS. SUVmax correlated significantly with baseline CRP levels, while no significant associations were observed with LDH or NLR. MTV was associated with LDH but not with CRP or NLR.
CONCLUSIONS: Baseline PET-derived metabolic parameters and systemic inflammatory biomarkers may provide complementary prognostic information in advanced NSCLC treated with first-line ICIs. Integrated clinical, metabolic, and inflammatory models showed improved prognostic performance, supporting further prospective validation of multimodal risk stratification strategies.
METHODS: Among 142 patients treated with first-line ICIs either as monotherapy or combined with chemotherapy, between October 2018 and December 2023, 116 had baseline PET/CT imaging. Quantitative analyses of standardized uptake value max (SUVmax) and metabolic tumor volume (MTV) were restricted to 71 patients whose scans were performed at our institution. Associations with response, progression free survival (PFS), and overall survival (OS) were analyzed.
RESULTS: In multivariable models including clinical variables, PET biomarkers and inflammatory markers, no individual PET or inflammatory biomarker remained independently associated with survival. Combined models suggested better prognostic discrimination compared with PET-only or inflammation-only models (OS C-index 0.745; PFS C-index 0.750). In contrast, sex, TTF-1 status, and the presence of adrenal and lung metastases emerged as independent predictors of OS and/or PFS. SUVmax correlated significantly with baseline CRP levels, while no significant associations were observed with LDH or NLR. MTV was associated with LDH but not with CRP or NLR.
CONCLUSIONS: Baseline PET-derived metabolic parameters and systemic inflammatory biomarkers may provide complementary prognostic information in advanced NSCLC treated with first-line ICIs. Integrated clinical, metabolic, and inflammatory models showed improved prognostic performance, supporting further prospective validation of multimodal risk stratification strategies.