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Efficacy evaluation of neoadjuvant immunotherapy plus chemotherapy for non-small-cell lung cancer: comparison of PET/CT with postoperative pathology

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

A Commentary to this article was published on 02 August 2023

Abstract

Objectives

To assess the value of positron emission tomography/computed tomography (PET/CT) in the efficacy evaluation of patients undergoing neoadjuvant immunotherapy plus chemotherapy, and to analyze its correlation with postoperative pathology.

Methods

The PET/CT metabolic parameters and CT size were retrospectively analyzed before and after neoadjuvant immunotherapy plus chemotherapy in 67 patients with resectable stage II/IIIA non-small-cell lung cancer (NSCLC). CT assessment based on immune response evaluation criteria in solid tumor criteria ((i)RECIST) was compared with PET/CT assessment based on the response criteria in solid tumors (PERCIST). The correlations between PET/CT metabolic parameters and postoperative pathology were analyzed. The value of PET/CT in the efficacy evaluation was assessed.

Results

The PET/CT assessment showed high consistency with postoperative pathological evaluation, yet the CT assessment showed low consistency with postoperative pathological evaluation. The (i)RECIST and PERCIST criteria showed statistically significant differences (p < 0.001). The postoperative pathological response was negatively associated with ΔSUVmax (%) (r =  − 0.812, p < 0.001), ΔSUVmean (%) (r =  − 0.805, p < 0.001), and ΔSUVpeak (%) (r =  − 0.800, p < 0.001). The cut-off values of 75.8 for ΔSUVmax (%), 67.8 for ΔSUVmean (%), and 74.6 for ΔSUVpeak (%) had the highest sensitivity and specificity.

Conclusion

The PERCIST criteria are more sensitive and accurate than (i)RECIST criteria to identify more responders when evaluating the response of neoadjuvant immunotherapy plus chemotherapy for NSCLC. PET/CT shows high accuracy in predicting postoperative pathological response. Our study shows the important role PET/CT plays in the efficacy evaluation of NSCLC patients undergoing neoadjuvant immunotherapy plus chemotherapy, as well as in predicting the prognosis and guiding postoperative treatment.

Clinical relevance statement

Neoadjuvant immunotherapy plus chemotherapy is highly effective in the treatment of non-small-cell lung cancer. And PET/CT played an important role in the efficacy evaluation following neoadjuvant immunotherapy plus chemotherapy for non-small-cell lung cancer.

Key Points

• Neoadjuvant immunotherapy plus chemotherapy is highly effective in the treatment of NSCLC.

• The PERCIST criteria are more sensitive and accurate than (i)RECIST criteria to identify more responders when evaluating the response of neoadjuvant immunotherapy plus chemotherapy for NSCLC.

• PET/CT played an important role in the efficacy evaluation; ΔSUVmax (%), ΔSUVmean (%), and ΔSUVpeak (%) following neoadjuvant immunotherapy plus chemotherapy for NSCLC had high consistency and strong correlations with postoperative pathology.

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Abbreviations

[18F]FDG:

18F-fluorodeoxyglucose

CEA:

Carcinoembryonic antigen

CECT:

Contrast-enhanced computed tomography

CMR:

Complete metabolic response

CYFRA21-1:

Cytokeratin 19 fragment antigen 21-1

iCPD:

Immune confirmed PD

iCR:

Immune complete response

iPR:

Immune partial response

iSD:

Immune stable disease

iUPD:

Immune unconfirmed progression

MPR:

Major pathological response

MTV:

Metabolic tumor volume

NSCLC:

Non-small-cell lung cancer

OS:

Overall survival

pCR:

Pathological complete response

PET/CT:

Positron emission tomography/computed tomography

PMD:

Progressive metabolic disease

PMR:

Partial metabolic response

SMD:

Stable metabolic disease

SUV:

Standardized uptake value

SUVmax :

Maximum SUV

SUVmean :

Mean SUV

SUVpeak :

Peak SUV

TLG:

Total lesion glycolysis

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Funding

This study has received funding by grants from the NSFC Incubation Program of GDPH (KY012021162) and the Joint Funds of Basic and Applied Basic Research Foundation of Guangdong Province of China (2019A1515110377).

Author information

Author notes

  1. You Cheng and Zhi-yong Chen contributed equally to this work.

Authors and Affiliations

  1. Department of PET Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Room 526, 5/F, Weilun Building, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, People’s Republic of China

    You Cheng & Dan Shao

  2. Department of Radiation Oncology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, People’s Republic of China

    Zhi-yong Chen

  3. Department of Pathology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, People’s Republic of China

    Jian-jiang Huang

Authors
  1. You Cheng
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  4. Dan Shao
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Corresponding author

Correspondence to Dan Shao.

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The scientific guarantor of this publication is Dr. Dan Shao.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because it is a retrospective study, the subjects cannot be found, and the research project does not involve personal privacy and commercial interests.

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Institutional Review Board approval was obtained.

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• retrospective

• prognostic study

• performed at one institution

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Cheng, Y., Chen, Zy., Huang, Jj. et al. Efficacy evaluation of neoadjuvant immunotherapy plus chemotherapy for non-small-cell lung cancer: comparison of PET/CT with postoperative pathology. Eur Radiol 33, 6625–6635 (2023). https://doi.org/10.1007/s00330-023-09922-4

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