In a groundbreaking study published in BMC Cancer, researchers have unveiled pivotal insights into the prognostic value of FDG-PET parameters derived from the torso region in patients suffering from advanced non-small cell lung cancer (NSCLC). This investigation, led by Obata and colleagues, meticulously examined how metabolic activity quantified by FDG-PET imaging correlates with clinical outcomes in individuals receiving first-line immunotherapy combined with platinum-based chemotherapy, marking a significant leap towards precision oncology for this challenging disease.
Non-small cell lung cancer, constituting the majority of lung cancer diagnoses, remains a formidable adversary due to its heterogeneity and typically late-stage presentation. Immune checkpoint inhibitors (ICIs) have revolutionized treatment paradigms, yet predicting patient response and survival remains elusive. Against this backdrop, metabolic imaging using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) emerges as a non-invasive approach that captures tumor glycolytic activity and burden—parameters that may reflect tumor aggressiveness and potential treatment resistance.
The retrospective study analyzed a cohort of 70 patients with stage III or IV NSCLC, all of whom underwent FDG-PET/computed tomography prior to initiation of first-line ICI–based combination therapy. The focus was on quantifying three primary metabolic metrics across all detectable lesions confined to the torso: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). These indices were employed not only to delineate tumor burden but also to explore their prognostic significance.
A notable aspect of the study was the emphasis on MTV and TLG, volumetric measurements representing the metabolically active tumor volume and lesion glycolytic activity, respectively. Unlike SUVmax, which captures peak glucose uptake in the tumor but may not account for tumor heterogeneity, volumetric parameters potentially provide a more holistic view of disease burden and metabolic aggressiveness.
In univariate analyses, Eastern Cooperative Oncology Group performance status (PS), MTV-torso, and TLG-torso showed significant associations with both progression-free survival (PFS) and overall survival (OS). Performance status, a clinical measure evaluating a patient’s ability to perform ordinary tasks, understandably impacts prognosis. However, the coupling of this clinical index with volumetric PET parameters strengthens the predictive framework, suggesting that combining metabolic imaging with clinical features enhances risk stratification accuracy.
The multivariate models further distilled MTV-torso and PS as independent prognostic biomarkers. Patients exhibiting lower tumor metabolic volumes within the torso experienced substantially prolonged survival durations, with mean PFS extending to over 580 days compared to less than 160 days for their counterparts with higher MTV-torso values. Likewise, overall survival nearly quadrupled for those with lower metabolic tumor burden. Such stark contrasts underscore the power of MTV-torso as a prognostic indicator, reinforcing its potential integration into clinical decision-making algorithms.
Interestingly, SUVmax-torso failed to demonstrate a significant correlation with survival outcomes in this cohort. This finding aligns with emerging evidence cautioning against sole reliance on maximum uptake values, which may overlook the intricate spatial and metabolic heterogeneity of tumor masses. Consequently, the study advocates for increased emphasis on volumetric parameters when leveraging FDG-PET data for prognostication.
The clinical implications of these findings are profound. By incorporating MTV-torso assessments into routine FDG-PET analyses for NSCLC patients slated for combined immunotherapy and chemotherapy, clinicians might better identify individuals at higher risk of disease progression and mortality. This prognostic enrichment could, in turn, guide personalized therapeutic intensification, closer monitoring protocols, or enrollment into clinical trials exploring novel agents.
Moreover, the focus on torso-based lesions—encompassing primary tumors and metastatic deposits within the chest, abdomen, and pelvis—reflects a realistic appraisal of disease dissemination patterns in advanced NSCLC. The metabolic tumor burden within this anatomical region serves as a representative surrogate for overall tumor load, streamlining imaging assessment and optimizing prognostic utility.
The methodology employed in this research is notable for its rigorous quantitative image analysis, providing replicable and objective metrics that transcend subjective interpretations. Utilizing Cox proportional hazards regression and Kaplan-Meier survival estimates ensured robust statistical assessments, enhancing the reliability of conclusions drawn. The retrospective design, while typical for such exploratory investigations, sets the stage for prospective validation studies to cement clinical applicability.
Beyond immediate prognostication, the study’s revelations about FDG-PET volumetric parameters may inspire further exploration into their role as predictive biomarkers for immunotherapy responsiveness. As the landscape of NSCLC treatment evolves, uncovering imaging correlates of immune activation or resistance could revolutionize patient selection and therapeutic tailoring, maximizing benefits while minimizing unnecessary toxicity.
This research also serves as a testament to the synergetic potential of multi-disciplinary collaboration, intertwining nuclear medicine, oncology, radiology, and biostatistics to unravel complex biological phenomena. The precision measurement of metabolic tumor burden unveils previously underappreciated dimensions of NSCLC biology, fostering a nuanced understanding capable of driving clinical innovation.
As we stride deeper into the era of personalized medicine, the integration of advanced imaging biomarkers like MTV-torso alongside molecular and genomic profiling promises to refine prognostic models substantially. The capacity to stratify patients not only on histopathological grounds but also on spatial and metabolic tumor characteristics heralds a future where therapies are meticulously calibrated to individual disease landscapes.
While challenges remain, including the need for standardized imaging protocols, harmonization of volumetric PET metrics across centers, and longitudinal validation, the promising results reported by Obata et al. undoubtedly galvanize the oncology community. These findings illuminate a path toward enhanced prognostic precision in advanced NSCLC, leveraging routinely acquired imaging data to inform pivotal clinical decisions.
In conclusion, the study convincingly positions torso-metabolic tumor volume measured by FDG-PET as a critical prognostic biomarker in patients with advanced non-small cell lung cancer undergoing first-line immunotherapy and chemotherapy. By transcending conventional metabolic metrics and focusing on holistic volumetric parameters, this research pioneers actionable insights that could transform patient management and outcomes in this formidable disease.
Subject of Research: Metabolic tumor burden assessment via FDG-PET as prognostic biomarkers in advanced non-small cell lung cancer patients undergoing first-line immunotherapy and chemotherapy.
Article Title: Torso FDG-PET parameters as prognostic biomarkers for advanced non-small cell lung cancer patients undergoing first-line immunotherapy and chemotherapy.
Article References:
Obata, T., Norikane, T., Manabe, Y. et al. Torso FDG-PET parameters as prognostic biomarkers for advanced non-small cell lung cancer patients undergoing first-line immunotherapy and chemotherapy. BMC Cancer 25, 1454 (2025). https://doi.org/10.1186/s12885-025-14873-8
Image Credits: Scienmag.com
DOI: https://doi.org/10.1186/s12885-025-14873-8
