Prognostic value of (18)F-FDG PET/CT in patients with advanced or metastatic non-small-cell lung cancer treated with immune checkpoint inhibitors: A systematic review and meta-analysis

PURPOSE: This study aimed to investigate the value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in predicting early immunotherapy response of immune checkpoint inhibitors (ICIs) in patients with advanced or metastatic non-small-cell lung cancer (NSCLC). METHODS: A comprehensive search of PubMed, Web of science, Embase and the Cochrane library was performed to examine the prognostic value of (18)F-FDG PET/CT in predicting early immunotherapy response of ICIs in patients with NSCLC. The main outcomes for evaluation were overall survival (OS) and progression-free survival (PFS). Detailed data from each study were extracted and analyzed using STATA 14.0 software. RESULTS: 13 eligible articles were included in this systematic review. Compared to baseline (18)F-FDG PET/CT imaging, the pooled hazard ratios (HR) of maximum and mean standardized uptake values SUV(max), SUV(mean), MTV and TLG for OS were 0.88 (95% CI: 0.69-1.12), 0.79 (95% CI: 0.50-1.27), 2.10 (95% CI: 1.57-2.82) and 1.58 (95% CI: 1.03-2.44), respectively. The pooled HR of SUV(max), SUV(mean), MTV and TLG for PFS were 1.06 (95% CI: 0.68–1.65), 0.66 (95% CI: 0.48-0.90), 1.50 (95% CI: 1.26-1.79), 1.27 (95% CI: 0.92-1.77), respectively. Subgroup analysis showed that high MTV group had shorter OS than low MTV group in both first line group (HR: 1.97, 95% CI: 1.39-2.79) and undefined line group (HR: 2.11, 95% CI: 1.61-2.77). High MTV group also showed a shorter PFS in first line group (HR: 1.85, 95% CI: 1.28-2.68), and low TLG group had a longer OS in undefined group (HR: 1.37, 95% CI: 1.00-1.86). No significant differences were in other subgroup analysis. CONCLUSION: Baseline MTV and TLG may have predictive value and should be prospectively studied in clinical trials. Baseline SUV(max) and SUV(mean) may not be appropriate prognostic markers in advanced or metastatic NSCLC patients treated with ICIs. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323906, identifier CRD42022323906.