浸润性肺腺癌18F-FDG PET/CT SUVmax值与PD-L1蛋白表达的关系

Relationship between SUVmax in 18F-FDG PET/CT and PD-L1 expression in invasive lung adenocarcinoma

目的研究浸润性肺腺癌组织中细胞程序性死亡分子-1配体(PD-L1)蛋白的表达和^18F-脱氧葡萄糖(^18F-FDG)正电子发射断层扫描/计算机断层扫描(PET/CT)最大标准化摄取值(SUVmax)的关系以及PD-L1和SUVmax值与临床因素的相关性。方法回顾性分析2016年8月至2018年11月于四川大学华西医院行肺癌切除手术且病理诊断为浸润性肺腺癌84例患者的临床资料,其中男38例、女46例,年龄60(32~85)岁。腺泡为主型37例,乳头为主型20例,贴壁为主型19例,实体为主型5例,微乳头为主型3例。对SUVmax值与其他临床病理特征的关系进行多因素线性回归分析;对PD-L1蛋白表达与其他病理特征的关系进行多因素logistic回归分析。结果在浸润性肺腺癌整体组(P=0.002)、中级别组织学亚型组(P=0.016),PD-L1表达组的SUVmax值显著高于非PD-L1表达组。对浸润性肺腺癌整体组及中级别组织学亚型组的PD-L1表达的SUVmax的界值作分析,分别为5.34[曲线下面积(AUC):0.732,P=0.002]、5.34(AUC:0.720,P=0.017)。多因素分析显示有胸膜受累、脉管癌栓及肿瘤直径的增加可增加SUVmax值,中分化相对于低分化可降低SUVmax值。低级别组织学亚型与中级别组织学亚型、中级别组织学亚型与高级别组织学亚型的SUVmax界值分别为1.54(AUC:0.854,P<0.001)、5.79(AUC:0.889,P<0.001)。多因素分析PD-L1的表达:胸膜受累[P=0.021,OR=0.022,95%CI(0.001,0.558)]及中分化(相对于低分化)[P=0.004,OR=0.053,95%CI(0.007,0.042)]可降低PD-L1的表达。结论浸润性肺腺癌整体组、中级别组织学亚型组中,PD-L1表达组的SUVmax值显著高于非PD-L1表达组。肺腺癌SUVmax值的高低及PD-L1表达与多种临床因素有关。

Objective To investigate the relationship between the expression of programmed cell death ligand-1(PD-L1)and the maximal standardized uptake value(SUVmax)in ^18F-fluorodeoxyglucose(FDG)positron emission tomography/computed tomography(PET/CT)and the correlation of clinical factors between SUVmax values and PD-L1.Methods The clinical data of 84 patients with invasive lung adenocarcinoma diagnosed pathologically in West China Hospital,Sichuan University from August 2016 to November 2018 were analyzed retrospectively,including 38 males and 46 females,aged 60(32-85)years.The tumor was acinar-predominant in 37 patients,papillary in 20,lepidic in 19, solid in 5 and micropapillary in 3. Multivariate analysis of the relationship between SUVmax value and otherclinicopathological features was performed by linear regression. Logistic regression analysis was used to analyze therelationship between PD-L1 protein expression and other pathological features. Results The SUVmax of the PD-L1expression group was significantly higher than that of the non-PD-L1 expression group in the whole invasive lungadenocarcinoma group (P=0.002) and intermediate-grade histologic subtype (P=0.016). The SUVmax cut-off value of PDL1 expression in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype was 5.34(AUC: 0.732, P=0.002) and 5.34 (AUC: 0.720, P=0.017), respectively. Multivariate analysis showed that pleurainvolvement, vascular tumor thrombus and the increase of tumor diameter could cause the increase of the SUVmax value,while the SUVmax value decreased in the moderately differentiated tumor compared with the poorly differentiated tumor.The SUVmax cut-off value between low-grade histologic subtype and intermediate-grade histologic subtype, intermediategrade histologic subtype and high-grade histologic subtypes was 1.54 (AUC: 0.854, P<0.001) and 5.79 (AUC: 0.889,P<0.001), respectively. Multivariate analysis of PD-L1 expression showed pleura involvement (P=0.021, OR=0.022, 95%CI0.001 to 0.558) and moderate differentiation (opposite to poor differentiation) (P=0.004, OR=0.053, 95%CI 0.007 to 0.042)decreased the expression of PD-L1. Conclusion The SUVmax of the PD-L1 expression group is significantly higher thanthat of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group and intermediate-gradehistologic subtype. The level of SUVmax and the expression of PD-L1 in invasive lung adenocarcinoma are related tomany clinical factors.