Clinical impact of inflammatory and nutrition index based on metabolic tumor activity in non‑small cell lung cancer treated with immunotherapy

Ito,Koki; Hashimoto,Kousuke; Kaira,Kyoichi; Yamaguchi,Ou; Mouri,Atsuto; Shiono,Ayako; Miura,Yu; Kobayashi,Kunihiko; Imai,Hisao; Kuji,Ichiei; Kagamu,Hiroshi

doi:10.3892/ol.2024.14243

Clinical impact of inflammatory and nutrition index based on metabolic tumor activity in non‑small cell lung cancer treated with immunotherapy

Authors:
- Koki Ito
- Kousuke Hashimoto
- Kyoichi Kaira
- Ou Yamaguchi
- Atsuto Mouri
- Ayako Shiono
- Yu Miura
- Kunihiko Kobayashi
- Hisao Imai
- Ichiei Kuji
- Hiroshi Kagamu
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Affiliations: Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Saitama 350‑1298, Japan, Department of Nuclear Medicine, International Medical Center, Saitama Medical University, Hidaka, Saitama 350‑1298, Japan
Published online on: January 19, 2024 https://doi.org/10.3892/ol.2024.14243
Article Number: 110

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Abstract

The aim of the present study was to explore the relationship between tumor metabolic glycolysis and inflammatory or nutritional status in patients with advanced non‑small cell lung cancer (NSCLC) who received programmed death‑1 (PD‑1) blockade. A total of 186 patients were registered in the present study. All of patients underwent ¹⁸F‑FDG PET imaging before initial PD‑1 blockade, and maximum standardized uptake value (SUV_max), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were assessed as indicators of ¹⁸F‑FDG uptake. As inflammatory and nutritional index, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ration (PLR), systemic immune inflammation index (SII), prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI) and Glasgow prognostic score (GPS) were evaluated based on previous assessment. ¹⁸F‑FDG uptake by MTV and TLG significantly correlated with the scores of NLR, PLR, SII, PNI and ALI, in addition to the level of albumin, lactate dehydrogenase, C‑reactive protein, white blood cells, neutrophils, lymphocytes and body mass index. The count of NLR, PLR and SII was significantly higher in patients with <1 year overall survival (OS) compared with in those with ≥1 year OS, and that of PNI and ALI was significantly lower in those with <1 year OS compared with those with ≥1 year OS. High MTV under the high PLR, SII and low ALI were identified as significant factors for predicting the decreased PFS and OS after PD‑1 blockade in a first‑line setting. In second or more lines, high MTV was identified as a significant prognostic predictor regardless of the levels of PLR, SII, ALI and GPS. In conclusion, metabolic tumor glycolysis determined by MTV was identified as a predictor for the outcome of PD‑1 blockade under the high inflammatory and low nutritional conditions, in particular, when treated with a first‑line PD‑1 blockade. A high MTV under high PLR and SII and low ALI in the first‑line setting could be more predictive of ICI treatment than other combinations.

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