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

作者：Cheng, You; Chen, Zhi-yong; Huang, Jian-jiang; Shao, Dan^*

来源：European Radiology, 2023, 33(10): 6625-6635.

DOI：10.1007/s00330-023-09922-4

• Carcinoma
• non-small-cell lung
• Immunotherapy
• Pathology

ObjectivesTo 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.MethodsThe 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.ResultsThe 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 & UDelta;SUVmax (%) (r = - 0.812, p < 0.001), & UDelta;SUVmean (%) (r = - 0.805, p < 0.001), and & UDelta;SUVpeak (%) (r = - 0.800, p < 0.001). The cut-off values of 75.8 for & UDelta;SUVmax (%), 67.8 for & UDelta;SUVmean (%), and 74.6 for & UDelta;SUVpeak (%) had the highest sensitivity and specificity.ConclusionThe 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.

• 单位
  南方医科大学; 5; 广东省人民医院