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PD-L1 in Lung Adenocarcinoma: Insights into the Role of 18F-FDG PET/CT

Authors Cui Y, Li X, Du B, Diao Y, Li Y

Received 4 April 2020

Accepted for publication 20 June 2020

Published 27 July 2020 Volume 2020:12 Pages 6385—6395

DOI https://doi.org/10.2147/CMAR.S256871

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Eileen O'Reilly


Yan Cui, Xuena Li, Bulin Du, Yao Diao, Yaming Li

Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China

Correspondence: Yaming Li
Department of Nuclear Medicine, The First Hospital of China Medical University, North Nanjing Street 155, Shenyang, Liaoning 110001, People’s Republic of China
Tel +86-24-83282142
Fax +86-24-83282671
Email ymli2001@163.com

Purpose: This study aimed to evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in expression of tumor programmed death ligand-1 (PD-L1) expression and prognostic significance of 18F-FDG PET/CT at different PD-L1 status in patients with lung adenocarcinoma.
Patients and Methods: Seventy-three patients with primary lung adenocarcinoma who received 18F-FDG PET/CT before treatment were retrospectively included in this study. Expression of tumor PD-L1, programmed death-1 (PD-1) and glucose metabolic parameters were evaluated.
Results: Tumor PD-L1 expression was positively correlated with maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), hexokinase II (HK-II) and glucose transporter 1 (GLUT-1) (P< 0.0001 for all). SUVmax was a unique independent predictor of tumor PD-L1 expression, with an optimal cut-off value of 9.5. For all the patients, tumor stage (P< 0.001) and SUVmax (P=0.009) were independent prognostic indicators of disease-free survival (DFS)/progression-free survival (PFS) while carcino-embryonic antigen (CEA) (P=0.003), Ki67 (P=0.042), PD-L1 (P=0.048) and TLG (P=0.004) were independent prognostic indicators of overall survival (OS). Tumor stage (P=0.004) and SUVmax (P=0.022) were independent prognostic indicators of DFS/PFS while TLG (P=0.012) and CEA (P=0.045) were independent prognostic indicators of OS in the PD-L1-positive group. In the PD-L1-negative group, tumor stage (P=0.002) and CEA (P=0.006) were unique independent prognostic indicators of DFS/PFS and OS, respectively.
Conclusion: 18F-FDG PET/CT may potentially predict tumor PD-L1 expression and play a role in predicting prognosis of PD-L1/PD-1 immunotherapy in lung adenocarcinoma.

Keywords: 18F-fluorodeoxyglucose, positron emission tomography, programmed death ligand-1, lung adenocarcinoma, prognosis

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