Objective:

To systematically examine whether baseline metabolic measurements from [18F] FDG PET/CT predict prognosis in patients receiving immune checkpoint inhibitor therapy for non-small cell lung cancer through a systematic review and meta-analysis.

Approach:

• Literature Search: Investigators searched five core databases for studies on NSCLC patient characteristics, metabolic parameters from [18F] FDG PET/CT, and survival outcomes.
• Data Extraction: Information was extracted on metabolic parameters and survival outcomes to evaluate the prognostic significance of SUVmax, SUVmean, MTV, and TLG.
• Statistical Analysis: Pooled hazard ratios (HRs) were calculated for overall survival (OS) and progression-free survival (PFS).

Key Findings:

• Thirty-three studies met inclusion criteria.
• Higher MTV and TLG were associated with worse PFS (MTV: HR = 1.71, 95% CI: 1.39–2.11; TLG: HR = 1.84, 95% CI: 1.31–2.57) and OS (MTV: HR = 1.80, 95% CI: 1.40–2.33; TLG: HR = 1.92, 95% CI: 1.18–3.12).
• MTV cut-off values of 50–100 cm³ showed the best predictive performance.
• MTV remained an independent predictor of PFS (HR = 1.21, 95% CI: 1.07–1.36) and OS (HR = 1.14, 95% CI: 1.03–1.26) in multivariable analysis.
• TLG retained independent prognostic significance for PFS (HR = 1.46, 95% CI: 1.10–1.94) but not for OS (HR = 1.00, 95% CI: 0.99–1.01).

Interpretation:

Baseline MTV independently predicts both PFS and OS in NSCLC patients receiving ICIs, while TLG's prognostic relevance for OS did not persist after multivariable adjustment.

Limitations:

• Non-standardized cutoff values for metabolic parameters.
• Limited evidence across different treatment lines and regimens.

Conclusion:

Baseline MTV is an independent prognostic factor for NSCLC patients undergoing ICI therapy.

Sources:

• Systematic Review Registration