Predictive value of baseline metabolic tumor volume for non-small-cell lung cancer patients treated with immune checkpoint inhibitors: A meta-analysis

Ke Zhu; Danqian Su; Jianing Wang; Zhouen Cheng; Yiqiao Chin; Luyin Chen; Chingtin Chan; Rongcai Zhang; Tianyu Gao; Xiaosong Ben; Chunxia Jing

doi:10.3389/fonc.2022.951557

Predictive value of baseline metabolic tumor volume for non-small-cell lung cancer patients treated with immune checkpoint inhibitors: A meta-analysis

Front Oncol. 2022 Sep 6:12:951557. doi: 10.3389/fonc.2022.951557. eCollection 2022.

Authors

Ke Zhu^{1

2}, Danqian Su^{1

2}, Jianing Wang^{1

2}, Zhouen Cheng^{1

2}, Yiqiao Chin^{1

2}, Luyin Chen^{1

2}, Chingtin Chan^{1

2}, Rongcai Zhang^{1

2}, Tianyu Gao¹, Xiaosong Ben³, Chunxia Jing^{1

4}

Affiliations

¹ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
² International School, Jinan University, Guangzhou, China.
³ Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴ Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, China.

Abstract

Background: Immune checkpoint inhibitors (ICIs) have emerged as a promising treatment option for advanced non-small-cell lung cancer (NSCLC) patients, highlighting the need for biomarkers to identify responders and predict the outcome of ICIs. The purpose of this study was to evaluate the predictive value of baseline standardized uptake value (SUV), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) derived from 18F-FDG-PET/CT in advanced NSCLC patients receiving ICIs.

Methods: PubMed and Web of Science databases were searched from January 1st, 2011 to July 18th, 2022, utilizing the search terms "non-small-cell lung cancer", "PET/CT", "standardized uptake value", "metabolic tumor volume", " total lesion glycolysis", and "immune checkpoint inhibitors". Studies that analyzed the association between PET/CT parameters and objective response, immune-related adverse events (irAEs) and prognosis of NSCLC patients treated with ICIs were included. We extracted the hazard ratio (HR) with a 95% confidence interval (CI) for progression-free survival (PFS) and overall survival (OS). We performed a meta-analysis of HR using Review Manager v.5.4.1.

Results: Sixteen studies were included for review and thirteen for meta-analysis covering 770 patients. As for objective response and irAEs after ICIs, more studies with consistent assessment methods are needed to determine their relationship with MTV. In the meta-analysis, low SUVmax corresponded to poor PFS with a pooled HR of 0.74 (95% CI, 0.57-0.96, P=0.02). And a high level of baseline MTV level was related to shorter PFS (HR=1.45, 95% CI, 1.11-1.89, P<0.01) and OS (HR, 2.72; 95% CI, 1.97-3.73, P<0.01) especially when the cut-off value was set between 50-100 cm³. SUVmean and TLG were not associated with the prognosis of NSCLC patients receiving ICIs.

Conclusions: High level of baseline MTV corresponded to shorter PFS and OS, especially when the cut-off value was set between 50-100 cm³. MTV is a potential predictive value for the outcome of ICIs in NSCLC patients.

Keywords: PET/CT (18)F-FDG; immune checkpoint inhibitor; metabolic tumor volume; non-small-cell lung cancer; standardized uptake value.

Publication types

Systematic Review