The following is a summary of “F-18 FDG PET-derived imaging biomarkers of airway inflammation and their clinical associations in patients with non-small cell lung cancer,” published in the February 2025 issue of the BMC Cancer by Oh et al.

Airway inflammation is increasingly recognized as a key factor in the pathogenesis and progression of non-small cell lung cancer (NSCLC). However, no study to date has systematically utilized quantified imaging biomarkers to assess airway inflammation in patients with NSCLC. This study aimed to test the hypothesis that airway inflammation is significantly more pronounced in patients with NSCLC compared to controls by employing airway imaging biomarkers derived from fluorine-18-fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET). Additionally, researchers explored the associations between these biomarkers and various clinical parameters, including tumor characteristics, systemic inflammatory markers, lung function, and smoking history. A retrospective cohort of 618 patients with NSCLC and 441 control subjects who underwent F-18 FDG PET/computed tomography (CT) was analyzed. 

Airway segmentation was performed on PET/CT images to quantify airway maximum standardized uptake value (SUVmax) and total lesion glycolysis (TLG), which served as surrogate markers of airway inflammation. Comparative analysis revealed that both airway SUVmax (P < 0.0001) and TLG (P < 0.0001) were significantly elevated in patients with NSCLC relative to controls. Further subgroup analysis indicated that patients with squamous cell carcinoma exhibited significantly higher airway SUVmax (P = 0.0098) and TLG (P < 0.0001) compared to those with adenocarcinoma. Correlation analysis demonstrated weak positive associations between airway SUVmax and TLG with tumor SUVmax, disease stage, white blood cell count, and neutrophil-to-lymphocyte ratio. Conversely, weak to moderate negative correlations were observed between airway PET parameters and lung function measures, suggesting that airway inflammation may contribute to pulmonary function decline in NSCLC. 

Additionally, airway TLG showed a moderate positive correlation with cumulative smoking exposure, as measured by smoking pack-years, further supporting the link between chronic airway inflammation and tumor development. These findings provide robust evidence that F-18 FDG PET-derived airway imaging biomarkers are elevated in patients with NSCLC and are associated with key clinical parameters, including tumor burden, disease progression, systemic inflammation, pulmonary function, and smoking history. By offering a noninvasive means to quantify airway inflammation, these biomarkers may serve as valuable tools for assessing NSCLC severity and progression. Moreover, their integration into clinical workflows could enhance risk stratification, guide personalized treatment strategies, and inform therapeutic interventions targeting airway inflammation in NSCLC management.

Source: bmccancer.biomedcentral.com/articles/10.1186/s12885-025-13727-7