Baseline 18F-FDG PET/CT metabolic parameters and systemic inflammatory markers in advanced NSCLC treated with first-line immunotherapy: an exploratory retrospective analysis

Resuli, Blerina; Walter, Julia; Völter, Friederike; Kauffmann-Guerrero, Diego; Dahlmann, Paul; Hirner, Raphael; Unterrainer, Lena; Mertsch, Pontus; Arnold, Paola; Mras, Paula; Leuschner, Gabriela; Rübenthaler, Johannes; Schneider, Christian; Behr, Jürgen; Tufman, Amanda (2026): Baseline 18F-FDG PET/CT metabolic parameters and systemic inflammatory markers in advanced NSCLC treated with first-line immunotherapy: an exploratory retrospective analysis. Frontiers in Oncology, 16: 1837219. ISSN 2234-943X

Abstract

Background: Predictive biomarkers for patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) remain limited. Systemic inflammation plays a crucial role in cancer progression and immune regulation. We evaluated whether baseline 18F-FDG PET/CT metabolic parameters and systemic inflammatory markers are associated with treatment response and survival in patients with advanced NSCLC treated with first-line ICIs.

Methods: Among 142 patients treated with first-line ICIs either as monotherapy or combined with chemotherapy, between October 2018 and December 2023, 116 had baseline PET/CT imaging. Quantitative analyses of standardized uptake value max (SUVmax) and metabolic tumor volume (MTV) were restricted to 71 patients whose scans were performed at our institution. Associations with response, progression free survival (PFS), and overall survival (OS) were analyzed.

Results: In multivariable models including clinical variables, PET biomarkers and inflammatory markers, no individual PET or inflammatory biomarker remained independently associated with survival. Combined models suggested better prognostic discrimination compared with PET-only or inflammation-only models (OS C-index 0.745; PFS C-index 0.750). In contrast, sex, TTF-1 status, and the presence of adrenal and lung metastases emerged as independent predictors of OS and/or PFS. SUVmax correlated significantly with baseline CRP levels, while no significant associations were observed with LDH or NLR. MTV was associated with LDH but not with CRP or NLR.

Conclusions: Baseline PET-derived metabolic parameters and systemic inflammatory biomarkers may provide complementary prognostic information in advanced NSCLC treated with first-line ICIs. Integrated clinical, metabolic, and inflammatory models showed improved prognostic performance, supporting further prospective validation of multimodal risk stratification strategies.

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 07 Medizin > Klinikum der LMU München > Klinik für Allgemeine, Viszeral-, Gefäß- und Transplantationschirurgie; 07 Medizin > Klinikum der LMU München > Medizinische Klinik und Poliklinik III (Onkologie); 07 Medizin > Klinikum der LMU München > Klinik und Poliklinik für Nuklearmedizin; 07 Medizin > Klinikum der LMU München > Klinik und Poliklinik für Radiologie
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892