The predictive value of total body PET/CT in high PD-L1 expression and immunotherapy in advanced non-small cell lung cancer patients

• Published in: Frontiers in oncology Vol. 15; p. 1578419
• Main Authors: Jin, Huibin, Hu, Bingxin, Zhang, Jie, Long, Ye, Xuan, Ang, Wu, Xinyu, Xu, Junling, Gao, Yongju
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 02.07.2025
• Subjects: immunotherapy; NSCLC; Oncology; PD-L1; prognosis; SUR; PD-L1; SUR; NSCLC; prognosis; immunotherapy
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2025.1578419

Total-body positron emission tomography/computed tomography (PET/CT) using uEXPLORER scanners demonstrates superior imaging capabilities for assessing programmed death ligand 1 (PD-L1) expression heterogeneity between primary tumors (PTs) and metastatic tumors (MTs) in advanced nonsmall cell lung cancer (NSCLC). This retrospective study of 99 treatment-naïve NSCLC patients revealed that metabolic parameters (SUVmax, SUR-L, and SUR-BP) derived from biopsy-correlated PET/CT sites significantly predicted high PD-L1 expression (TC ≥ 50% or IC ≥ 10% by IHC). SUR-L exhibited the highest diagnostic accuracy (AUC = 0.758, < 0.001). Among 30 immunotherapytreated patients, PD-L1 positivity and SUR-BP ≥ 7.30 were associated with prolonged disease-free survival (DFS) ( = 0.012 and = 0.035, respectively). Our findings establish SUR-BP as a novel non-invasive biomarker for immunotherapy prognosis in NSCLC, addressing spatial heterogeneity challenges in PD-L1 assessment.