Association between 18F-FDG metabolic activity and programmed death ligand-1 (PD-L1) expression using 22C3 immunohistochemistry assays in non-small cell lung cancer (NSCLC) resection specimens

Author:

Zhao Long1,Liu Jinjun1,Wang Huoqiang1ORCID,Shi Jingyun2

Affiliation:

1. Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai 200433, China

2. Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai 200433, China

Abstract

Objective: This study sought to investigate the association between 18F-fludeoxyglucose (18F-FDG) uptake in positron emission tomography/CT (PET/CT) scans and different programmed death ligand-1 (PD-L1) expression conditions in non-small cell lung cancer (NSCLC). Methods: From October 2017 to December 2019, NSCLC was retrospectively identified in 419 consecutive patients who underwent 18F-FDG PET/CT scans and PD-L1 expression tests using the PD-L1 22C3 assay. The association between clinicopathological characteristics and PD-L1 expression was assessed. Results: The frequency of PD-L1-positive tumours was 38.2% (160/419) in NSCLC. In NSCLC, the multivariate analysis showed a high maximum standardised uptake value (SUVmax) (p < 0.0001) and an EGFR wild type genotype (p = 0.027) was significantly associated with PD-L1-positivity. In adenocarcinoma (ADC), the multivariate analysis showed that a high SUVmax (p < 0.0001) was significantly associated with PD-L1-positivity. In NSCLC and ADC, a Mann–Whitney U test showed significant differences between groups with PD-L1 high expression and PD-L1 low expression levels in terms of SUVmax (p = 0.011 and p = 0.013, respectively). The results of the receiver operating characteristic curve analysis showed that the area under the curve of the SUVmax was 0.767 (95% CI, 0.720–0.814; p < 0.0001) and 0.712 (95% CI, 0.651–0.774; p < 0.0001) in NSCLC and ADC, respectively. Conclusion: The study demonstrates that the SUVmax was significantly associated with PD-L1 expression in NSCLC and ADC. The SUVmax was significantly different between the PD-L1 high and low expression conditions, as quantified using a PD-L1 22C3 assay. Advances in knowledge: This study provides direct evidence that SUVmax as a metabolic biomarker may help select patients with NSCLC likely to benefit from pembrolizumab.

Publisher

British Institute of Radiology

Subject

Radiology Nuclear Medicine and imaging,General Medicine

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