Objectives

We aimed to compare the prognostic value of inflammatory biomarkers extracted from pretreatment peripheral blood and [18F]-FDG PET for estimating outcomes in non-small cell lung cancer (NSCLC) patients treated with first-line immunotherapy (IT) or chemotherapy (CT).

Materials and methods

In this retrospective multicenter study, we evaluated 111 patients with advanced NSCLC who underwent baseline [18F]-FDG PET/CT before IT or CT between 2016 and 2019. Several blood inflammatory indices were evaluated: derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and systemic immune-inflammation index (SII). FDG-PET inflammatory parameters were extracted from lymphoid tissues (BLR and SLR: bone marrow or spleen-to-Liver SUVmax ratios). Association with survival and relationships between parameters were evaluated using Cox prediction models and Spearman's correlation respectively.

Results

Overall, 90 patients were included (IT:CT) (51:39pts). Median PFS was 8.6:6.6 months and median OS was not reached:21.2 months. In the IT cohort, high dNLR (>3), high SII (≥1,270) and high SLR (0.77) were independent statistically significant prognostic factors for one-year progression-free survival (1y-PFS) and two-year overall survival (2y-OS) on multivariable analysis. In the CT cohort, high BLR (≥0.80) and high dNLR (>3) were associated with shorter 1y-PFS (HR 2.2, 95% CI 1.0–4.9) and 2y-OS (HR 3.4, 95CI 1.1–10.3) respectively, on multivariable analysis. Finally, BLR significantly but moderately correlated with most blood-based inflammatory indices (CRP, PLR and SII) while SLR was only associated with CRP (p < 0.01 for all).

Conclusion

In advanced NSCLC patients undergoing first-line IT or CT, pretreatment blood and inflammatory factors evaluating the spleen or bone marrow on [18F]-FDG PET/CT provided prognostic information for 1y-PFS and 2y-OS. These biomarkers should be further evaluated for potential clinical application.

中文翻译：

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使用外周血和 [18F]-FDG PET/CT 的炎症反应生物标志物在一线化疗或免疫治疗的晚期 NSCLC 患者中的预后价值

目标

我们旨在比较从治疗前外周血中提取的炎症生物标志物和 [18F]-FDG PET 对评估一线免疫疗法 (IT) 或化疗 (CT) 治疗的非小细胞肺癌 (NSCLC) 患者预后的价值.

材料和方法

在这项回顾性多中心研究中，我们评估了 111 名晚期 NSCLC 患者，这些患者在 2016 年至 2019 年期间在 IT 或 CT 之前接受了基线 [18F]-FDG PET/CT。评估了几个血液炎症指标：衍生的中性粒细胞与淋巴细胞比率 (dNLR) 、血小板对淋巴细胞比率 (PLR)、C 反应蛋白 (CRP) 和全身免疫炎症指数 (SII)。从淋巴组织中提取 FDG-PET 炎症参数（BLR 和 SLR：骨髓或脾肝 SUVmax 比率）。分别使用 Cox 预测模型和 Spearman 相关性评估与生存的关联和参数之间的关系。

结果

总体而言，包括 90 名患者 (IT:CT) (51:39pts)。中位 PFS 为 8.6:6.6 个月，中位 OS 未达到：21.2 个月。在 IT 队列中，高 dNLR (>3)、高 SII (≥1,270) 和高 SLR (0.77) 是一年无进展生存 (1y-PFS) 和两年总生存的独立统计学显着预后因素。 2y-OS) 进行多变量分析。在 CT 队列中，高 BLR (≥0.80) 和高 dNLR (>3) 分别与较短的 1y-PFS (HR 2.2, 95% CI 1.0–4.9) 和 2y-OS (HR 3.4, 95CI 1.1–10.3) 相关, 多变量分析。最后，BLR 与大多数基于血液的炎症指数（CRP、PLR 和 SII）显着但中度相关，而 SLR 仅与 CRP 相关（所有 p < 0.01）。

结论

在接受一线 IT 或 CT 的晚期 NSCLC 患者中，在 [18F]-FDG PET/CT 上评估脾脏或骨髓的预处理血液和炎症因子提供了 1y-PFS 和 2y-OS 的预后信息。应进一步评估这些生物标志物的潜在临床应用。