SUVmax-IPI as a New Prognostic Index in Metastatic Non-Small Cell Lung Cancer Patients Receiving Nivolumab.

[BACKGROUND/OBJECTIVES] Nivolumab has significantly improved outcomes in patients with metastatic non-small cell lung cancer (NSCLC); however, reliable prognostic biomarkers remain an unmet need. To address this gap, we developed the SUVmax-IPI, a novel prognostic index combining maximum standardized uptake value (SUVmax) from F-fluorodeoxyglucose positron emission tomography (FDG-PET) with systemic inflammatory markers. This study aimed to evaluate the prognostic value of SUVmax-IPI in patients with NSCLC receiving nivolumab therapy.

[METHODS] This multicenter retrospective analysis included 187 patients with metastatic NSCLC receiving nivolumab across 5 tertiary institutions. The SUVmax-IPI incorporated pretreatment SUVmax and laboratory-based inflammatory prognostic index (IPI) parameters. Survival outcomes were evaluated using Kaplan-Meier analysis with log-rank testing and multivariate cox regression.

[RESULTS] Receiver operating characteristic (ROC) analysis established an optimal SUVmax-IPI cut-off of 241.9. Patients with SUVmax-IPI ≤ 241.9 had significantly better survival outcomes: median overall survival (OS) was 35 versus 15 months ( = 0.002). For progression-free survival (PFS), although a numerical difference favored patients with SUVmax-IPI ≤ 241.9 (median: 15 vs. 8 months), this did not reach statistical significance (log-rank = 0.175). Multivariate analysis confirmed SUVmax-IPI as an independent predictor of survival ( = 0.002).

[CONCLUSIONS] The SUVmax-IPI represents a promising prognostic tool for patients with metastatic NSCLC who received at least 3 months of nivolumab, integrating metabolic and inflammatory parameters to predict survival outcomes.