The Relationships Between Peripheral Blood Immune Cells And Tumor PET/CT SUVmax And Infiltrating Immune Cells In NSCLC

Background:Lung cancer is the leading cause of cancer-related death in men and women worldwide.Non-small cell lung cancer(NSCLC)accounts for 85%of lung cancer Metabolic parameters of 18F-FDG-PET-CT play an important role in the prognosis evaluation of non-small cell lung cancer by calculating sugar absorption rate to evaluate the malignancy of tumors.Hematological parameters of systemic inflammation based on circulating blood cell count as prognostic markers of tumors are attracting wide attention.Increasing evidence supports that these blood cell counts can help predict the prognosis of multiple tumors.Because the inflammation process of tumors has a significant impact on FDG uptake,it is presumed that there is a certain relationship between FDG uptake and hematological parameters related to prognosis in tumors,but this possibility has not been explored before.Therefore,we explored the relationship between FDG uptake and circulating blood cell parameters in patients with non-small cell lung cancer,and further studied their predictive value for prognosis.In addition to tumor cells,FDG can also be uptake by tumor-related activated immune cells.The exact correlation between metabolic status and the composition of immune cells,and whether locally infiltrated immune cells are associated with circulating cells are not clear.Therefore,exploring the relationship between metabolic variables and immune cells in tumor microenvironment will help to discover new mechanisms of tumor progression and explore predictors of immune response.FDG-PET can accurately display the metabolic status of tumor microenvironment and help to clarify the interaction between metabolic and immune pathways.We further examined the main parameters of PET in patients with non-small cell lung cancer(NSCLC)-maximal standard uptake(SUVmax)and tumor-infiltrating immune cells,explored the correlation between immune and metabolic parameters,and analyzed the role of these variables in prognosis.Methods:We collected medical records of 747 patients with non-small cell lung cancer from May 2005 to October 2014.The relationship between peripheral blood immune cells and PET/CT SUVmax and its influence on prognosis were analyzed.Immunohistochemical method was used to detect the expression of tumor infiltrating immune cells in 122 of them.To analyze the correlation between the expression level of tumor infiltrating immune cells and PET/CT SUVmax and peripheral blood immune cells,and to explore its role in prognosis.Results:The distribution of immune cells in peripheral blood was different among different sex,age,tumor size,TNM stage and pathological type(P<0.05),but there was no difference between smoking and lymph node metastasis(P>0.05).The value of PET/CT SUVmax was higher in male,smoker,tumor diameter>3 cm,lymph node metastasis and TNM stage Ⅲ-Ⅳ,squamous cell carcinoma and elderly patients(P<0.05).PET/CT SUVmax was significantly correlated with peripheral blood leukocyte count,neutrophil count,NLR,monocyte count and LMR(P<0.001).Increased SUVmax and late TNM staging were adverse prognostic indicators(P<0.05).Peripheral blood immune cells had no predictive value for PFS,but lymphocyte count and LMR value had predictive value for OS(P=0.029,P=0.004).The risk function combined with SUVmax and peripheral blood immune cell index has good predictive value for OS of different stages.Further analysis of the relationship between tumor infiltrating immune cells and SUVmax showed that the expression of CD163+TAMs was positively correlated with SUVmax(r=0.220;P=0.014).The expression level of CD68+TAMs was positively correlated with the proportion of peripheral blood mononuclear cells(r=0.2067,P=0.023).TNM stage and CD11c+DCs were independent prognostic factors for PFS and OS.Peripheral blood immune cells had no predictive value for PFS,and NLR had predictive value for OS P=0.020).Conclusion:This study revealed the correlation between metabolic markers and tumor immune cells in whole body and infiltrating immune cells in local microenvironment.It indicated that peripheral blood immune cells had a certain relationship with SUVmax SUVmax could improve the local immune status of tumors to a certain extent.The risk function established by combining SUVmax value with peripheral blood immune markers could play a better role in predicting OS.