Prognostic value of total tumour volume, adding necrosis to metabolic tumour volume, in advanced or metastatic non-small cell lung cancer treated with first-line pembrolizumab.
Aged
Antibodies, Monoclonal, Humanized
Carcinoma, Non-Small-Cell Lung
/ diagnostic imaging
Fluorodeoxyglucose F18
/ metabolism
Humans
Lung Neoplasms
/ diagnostic imaging
Necrosis
Positron Emission Tomography Computed Tomography
Positron-Emission Tomography
Prognosis
Radiopharmaceuticals
Retrospective Studies
Tumor Burden
Immunotherapy
Metabolic tumour volume
Necrosis
Necrotic tumour volume
Non-small cell lung carcinoma
Nuclear medicine
Pembrolizumab
Positron emission tomography
Predictive factor
Prognostic factor
Journal
Annals of nuclear medicine
ISSN: 1864-6433
Titre abrégé: Ann Nucl Med
Pays: Japan
ID NLM: 8913398
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
04
08
2021
accepted:
08
11
2021
pubmed:
22
1
2022
medline:
5
4
2022
entrez:
21
1
2022
Statut:
ppublish
Résumé
Metabolic tumour volume (MTV) measured on fluorodeoxyglucose F18 (FDG) positron emission tomography coupled with computed tomography (PET/CT) is a prognostic factor of advanced non-small cell lung cancer (NSCLC) treated by first-line immunotherapy. However, these tumours are often necrotic and the necrosis, which is hypometabolic in PET FDG, is not included in the MTV. The aim of this study was to evaluate the prognostic value of total tumour volume (TTV), adding necrotic tumour volume (NTV) to metabolic tumour volume (MTV). We retrospectively included 65 patients with NSCLC treated with pembrolizumab as monotherapy. All patients had a pretreatment FDG PET/CT. PET/CT measured parameters were MTV, NTV and TTV. Clinical, biological and tumour parameters were also retrieved. Receiver operator characteristics (ROC) analysis was performed and overall survival at 1 year was studied using Kaplan-Meier and uni/multivariate Cox analysis. In the ROC analysis, MTV, NTV, TTV, age at diagnosis, polynuclear blood neutrophil, derived neutrophil/leukocyte ratio (dNLR), and haemoglobin had an area under the curve (AUC) significantly higher than 0.5. In Kaplan-Meier analysis, prognosis was worse for patients with high MTV (p = 0.02), high TTV (p = 0.003), high NTV (p = 0.014), low haemoglobin (p < 0.001), older people (p = 0.002), neutrophil polynucleosis (p < 0.001) and dNLR (p = 0.022). All these parameters, except age and neutrophil polynucleosis, were significant prognostic factors in univariate Cox analysis (p < 0.05). In a stepwise multivariate Cox analysis focused on PET parameters, the only significant parameter was TTV (HR = 3.66, p = 0.002) and in a stepwise multivariate Cox analysis exploring all the parameters, a model combining TTV, performance status and brain metastasis was found (p = 0.002). TTV and NTV measured on pretreatment FDG PET/CT are significant prognosis factor for stage III-IV NSCLC treated by pembrolizumab and TTV could have a higher prognostic value than MTV.
Sections du résumé
BACKGROUND
BACKGROUND
Metabolic tumour volume (MTV) measured on fluorodeoxyglucose F18 (FDG) positron emission tomography coupled with computed tomography (PET/CT) is a prognostic factor of advanced non-small cell lung cancer (NSCLC) treated by first-line immunotherapy. However, these tumours are often necrotic and the necrosis, which is hypometabolic in PET FDG, is not included in the MTV. The aim of this study was to evaluate the prognostic value of total tumour volume (TTV), adding necrotic tumour volume (NTV) to metabolic tumour volume (MTV).
METHODS
METHODS
We retrospectively included 65 patients with NSCLC treated with pembrolizumab as monotherapy. All patients had a pretreatment FDG PET/CT. PET/CT measured parameters were MTV, NTV and TTV. Clinical, biological and tumour parameters were also retrieved. Receiver operator characteristics (ROC) analysis was performed and overall survival at 1 year was studied using Kaplan-Meier and uni/multivariate Cox analysis.
RESULTS
RESULTS
In the ROC analysis, MTV, NTV, TTV, age at diagnosis, polynuclear blood neutrophil, derived neutrophil/leukocyte ratio (dNLR), and haemoglobin had an area under the curve (AUC) significantly higher than 0.5. In Kaplan-Meier analysis, prognosis was worse for patients with high MTV (p = 0.02), high TTV (p = 0.003), high NTV (p = 0.014), low haemoglobin (p < 0.001), older people (p = 0.002), neutrophil polynucleosis (p < 0.001) and dNLR (p = 0.022). All these parameters, except age and neutrophil polynucleosis, were significant prognostic factors in univariate Cox analysis (p < 0.05). In a stepwise multivariate Cox analysis focused on PET parameters, the only significant parameter was TTV (HR = 3.66, p = 0.002) and in a stepwise multivariate Cox analysis exploring all the parameters, a model combining TTV, performance status and brain metastasis was found (p = 0.002).
CONCLUSIONS
CONCLUSIONS
TTV and NTV measured on pretreatment FDG PET/CT are significant prognosis factor for stage III-IV NSCLC treated by pembrolizumab and TTV could have a higher prognostic value than MTV.
Identifiants
pubmed: 35060071
doi: 10.1007/s12149-021-01694-5
pii: 10.1007/s12149-021-01694-5
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Radiopharmaceuticals
0
Fluorodeoxyglucose F18
0Z5B2CJX4D
pembrolizumab
DPT0O3T46P
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
224-234Informations de copyright
© 2021. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.
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