Relationship between tumor mutational burden and maximum standardized uptake value in 2-[¹⁸F]FDG PET (positron...

Deriving links between imaging and genomic markers is an evolving field. 2-[¹⁸F]FDG PET/CT (¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography) is commonly used for cancer imaging, with maximum standardized uptake value (SUV_max) as the main quantitative parameter. Tumor mutational burden (TMB), the quantitative variable obtained using next-generation sequencing on a tissue biopsy sample, is a putative immunotherapy response predictor. We report the relationship between TMB and SUV_max, linking these two important parameters.

In this pilot study, we analyzed 1923 patients with diverse cancers and available TMB values. Overall, 273 patients met our eligibility criteria in that they had no systemic treatment prior to imaging/biopsy, and also had 2-[¹⁸F]FDG PET/CT within 6 months prior to the tissue biopsy, to ensure acceptable temporal correlation between imaging and genomic evaluation.

We found a linear correlation between TMB and SUV_max (p < 0.001). In the multivariate analysis, only TMB independently correlated with SUV_max, whereas age, gender, and tumor organ did not.

Our observations link SUV_max in readily available, routinely used, and noninvasive 2-[¹⁸F]FDG PET/CT imaging to the TMB, which requires a tissue biopsy and time to process. Since higher TMB has been implicated as a prognostic biomarker for better outcomes after immunotherapy, further investigation will be needed to determine if SUV_max can stratify patient response to immunotherapy.