Assessing the role of colonic and other anatomical sites uptake by [18 F]FDG-PET/CT and immune-inflammatory peripheral blood indexes in patients with advanced non-small cell lung cancer treated with first-line immune checkpoint inhibitors

Alessio Rizzo; Ornella Cantale; Andrea Mogavero; Lucia Garetto; Manuela Racca; Tiziana Venesio; Shobana Anpalakhan; Silvia Novello; Vanesa Gregorc; Giuseppe Luigi Banna

doi:10.1111/1759-7714.15032

Assessing the role of colonic and other anatomical sites uptake by [¹⁸ F]FDG-PET/CT and immune-inflammatory peripheral blood indexes in patients with advanced non-small cell lung cancer treated with first-line immune checkpoint inhibitors

Thorac Cancer. 2023 Aug;14(24):2473-2483. doi: 10.1111/1759-7714.15032. Epub 2023 Jul 13.

Authors

Affiliations

¹ Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy.
² Department of Oncology, University of Turin, San Luigi Hospital, Turin, Italy.
³ Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
⁴ Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.

Abstract

Background: Inflammation in non-small cell lung cancer (NSCLC) may impair the response to immune checkpoint inhibitors (ICIs) and can be indicated by peripheral blood inflammatory indexes. 2-deoxy-2-[¹⁸ F]fluoro-D-glucose positron emission tomography/computed tomography ([¹⁸ F] FDG-PET/CT) may be used as a marker of inflammation by measuring glucose metabolism in different colonic sites.

Methods: This retrospective analysis aimed to investigate the correlation between [¹⁸ F] FDGPET/CT SUV_ratio in six gastrointestinal districts, the spleen, the pharynx and the larynx alongside the most avid tumor lesion with peripheral blood inflammatory indexes, including the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammatory index (SII, i.e., NLR times platelets) and lactate dehydrogenase (LDH), in patients with [¹⁸ F] FDG-PET/CT staged IV NSCLC who received first-line immune checkpoint inhibitors (ICIs). The role of SUV_ratios and peripheral blood inflammatory indexes in predicting overall survival (OS) and progression-free survival (PFS) was then explored.

Results: A total of 43 patients were treated with first-line ICI alone (58%) or in combination with chemotherapy (42%). A significant correlation was only found between the rectosigmoid SUV_ratio and NLR (p = 0.0465). NLR >5.5 and LDH > 333.5 were associated with a worse OS (p = 0.033 and p = 0.009, respectively). The SII was associated with a worse PFS in patients treated with ICI alone (p = 0.033). None of the SUV_ratios were significantly associated with OS or PFS, although a high left colon SUV_ratio showed a trend toward a worse PFS.

Conclusion: There was no significant correlation between [¹⁸ F]FDG PET/CT uptake in different anatomical sites, and in the tumor, and systemic immune-inflammatory indexes. The prognostic role of high left colon SUV_ratio deserves further investigation.

Keywords: NLR; gut microbiome; immune checkpoint inhibitor; immunotherapy; lung cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Non-Small-Cell Lung* / diagnostic imaging
Carcinoma, Non-Small-Cell Lung* / drug therapy
Fluorodeoxyglucose F18 / therapeutic use
Humans
Immune Checkpoint Inhibitors / pharmacology
Immune Checkpoint Inhibitors / therapeutic use
Inflammation / drug therapy
Lung Neoplasms* / diagnostic imaging
Lung Neoplasms* / drug therapy
Lung Neoplasms* / metabolism
Positron Emission Tomography Computed Tomography / methods
Prognosis
Retrospective Studies

Substances

Fluorodeoxyglucose F18
Immune Checkpoint Inhibitors