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

Abstract

Purpose: This study aimed to evaluate the role of 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) in expression of tumor programmed death ligand-1 (PD-L1) expression and prognostic significance of 18 F-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 18 F-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: 18 F-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: 18 F-fluorodeoxyglucose, positron emission tomography, programmed death ligand-1, lung adenocarcinoma, prognosis