Journals / Journal of Health Sciences and Medicine / 2026 / Volume: 8 Issue: 4

Relationship between spleen volume, spleen/liver SUVmax ratio, and percentage change and overall survival in patients undergoing immunotherapy

İmmunoterapi alan hastaların dalak hacmi, dalak/karaciğer SUVmax oranı ve değişim yüzdelerinin genel sağkalım arasındaki ilişki

İhsan Kaplan(UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE)0000-0002-5727-4702
Özlem Beyler(UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE)0000-0002-2032-8877
Pages
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Publication Date
2025-07-30
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AI Summary & Key Takeaways

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⚡ TL;DR(Too Long; Didn't Read)

Aims: This study aimed to investigate the pre- and post-treatment associations between spleen volume (SV), spleen/liver maximum standardized uptake value (SUVmax) ratio (SLR), and percent change (Δ) and overall survival (OS) in patients undergoing immunotherapy.

📌 3 Key Takeaways

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Objective & Hypothesis:Aims: This study aimed to investigate the pre- and post-treatment associations between spleen volume (SV), spleen/liver maximum standardized uptake value (SUVmax) ratio (SLR), and percent change (Δ) and overall survival (OS) in patients undergoing immunotherapy.
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Key Findings & Data:Methods: This retrospective study included 89 patients who underwent 18F FDG PET/CT imaging before immunotherapy (baseline) and during post-treatment at 3 and 6 months.
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Conclusion & Impact:Higher SLR1 and SLR3 values from 18F FDG PET/CT before and at 6 months post-treatment were independent prognostic factors and associated with shorter OS.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:FDG PET/CT · immunotherapy · spleen volume

Abstract

Aims: This study aimed to investigate the pre- and post-treatment associations between spleen volume (SV), spleen/liver maximum standardized uptake value (SUVmax) ratio (SLR), and percent change (Δ) and overall survival (OS) in patients undergoing immunotherapy. Methods: This retrospective study included 89 patients who underwent 18F FDG PET/CT imaging before immunotherapy (baseline) and during post-treatment at 3 and 6 months. SV, spleen SUVmax, and liver SUVmax parameters were determined based on PET/CT images. Patients’ ages and date of mortality were recorded. Results: In the present study, 52 (58.4%) were men, and the median OS was 17.7 (4-83) months. Furthermore, 63 out of 89 patients (70.8%) died during the study period. Baseline median SV value was 230 ml (47-1870). Baseline median SLR value was 0.80 (0.33-1.48). Median ΔSV1 at baseline and at 3 months post-treatment was -1.34 (-55.03-155.37). Percent change in SLR baseline and post-treatment (ΔSLR1) median was -0.52 (-48.39-121.02). Moreover, SLR1 had a sensitivity of 64.2% and specificity of 65.2% in detecting mortality with a cutoff value of >0.80. For a SLR1 value of ≤0.79, median OS was 29.5 months and 1-3-year survival was 87/37%. SLR1 and SLR3 were independent prognostic factors for OS (p=0.003 and p=0.004, respectively). Conclusion: SV values before and at 3 months post-immunotherapy and SLR values before and at 6 months post-treatment were prognostic factors for OS. Higher SLR1 and SLR3 values from 18F FDG PET/CT before and at 6 months post-treatment were independent prognostic factors and associated with shorter OS.

Özet

Amaçlar: Amacımız immunoterapi alanlarda tedavi öncesi ve tedavi sonrası dalak hacmi (SV), dalak/karaciğer SUVmax oranı (SLR) ve değişim yüzdelerinin (Δ) genel sağkalım (OS) arasındaki ilişkisini araştırmaktır. Yöntemler: Çalışmamız retrospektif olarak Ekim 2017-Kasım 2023 tarihleri arasında immunoterapi öncesinde (bazal), tedavi sonrası 3. ay ve 6. ayında FDG PET/BT görüntülemeleri yapılan hastalar alındı. Hastaların 89’una bazal ve tedavi sonrası 3 ay, 53’ünde ise bazal, tedavi sonrası 3. ve 6. ay PET/BT görüntülemeleri yapıldı. FDG PET/BT’nin CT görüntüleri ile bazal, tedavi sonrası 3. ve 6. ayında dalak hacmi, füzyon görüntüleri dalak SUVmax, karaciğer SUVmax parametereleri ölçüldü. Hasta yaşı ve ölüm tarihleri kayıt altına alındı. Bulgular: Çalışmamızda hastaların 52’si (%58.4) erkek ve median yaşı 62 (23-91) olarak bulundu. OS median 17.7 (4-83) ay olarak bulundu. Bazal median SV 230 mL (47-1870)’idi. Bazal SLR1 median değeri 0.80 (0.33-1.48) olarak bulundu. Bazal ve tedavi sonrası 3 aydaki ΔSV1 median -1.34 (-55.03-155.37) idi. SLR bazal ve tedavi sonrası değişim yüzdesi (ΔSLR1) median -.52 (-48.39-121.02). SLR1 cut-off değeri > 0.80 alındığında mortaliteyi tespit etmede % 64.2 sensitivite ve % 65.2 spesifiteye sahipti. Çalışma süresince 89 hastanın 63’si (% 70.8) öldüğü saptandı. SLR1 değeri için ≤ 0.79 median OS 29.5 ay olup 1-3 yıllık sağkalım % 87/37 bulundu. SLR1 ve SLR3 değerinin OS üzerine bağımsız prognostik faktör olduğu tespit edildi (sırasıyla p = 0.003 ve p = 0.004). Sonuç: İmmunoterapi öncesi ve tedavi sonrası 3. ayında SV değerleri ile tedavi öncesi ve tedavi sonrası 6. ay sonraki SLR değerleri OS üzerine prognostik faktörler olduğunu tespit ettik. Tedavi öncesi ve tedavi sonra 6.ayda FDG PET/BT’den elde edilen SLR1 değeri için > 0.79 ve SLR3 değeri için > 0.80 olanlar daha kısa OS sahiptiler ve OS için bağımsız prognostik faktörler olduğunu bulduk.

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Cite This Article

Kaplan, İ., Beyler, Ö. (2025). Relationship between spleen volume, spleen/liver SUVmax ratio, and percentage change and overall survival in patients undergoing immunotherapy. Journal of Health Sciences and Medicine, Volume: 8 Issue: 4. https://doi.org/10.32322/jhsm.1689929

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References (41)

  1. Ribas A, Wolchok JD. Cancer immunotherapy using checkpoint blockade. Science. 2018;359(6382):1350-1355. doi:10.1126/science.aar40 60
  2. Tang J, Yu JX, Hubbard-Lucey VM, Neftelinov ST, Hodge JP, Lin Y. Trial watch: the clinical trial landscape for PD1/PDL1 immune checkpoint inhibitors. Nat Rev Drug Discov. 2018;17(12):854-855. doi:10.1038/nrd. 2018.210
  3. Yi M, Zheng X, Niu M, Zhu S, Ge H, Wu K. Combination strategies with PD-1/PD-L1 blockade: current advances and future directions. Mol Cancer. 2022;21(1):28. doi:10.1186/s12943-021-01489-2
  4. Gandhi L, Rodríguez-Abreu D, Gadgeel S, et al. Pembrolizumab plus chemotherapy in metastatic non-small-cell lung cancer. N Engl J Med. 2018;378(22):2078-2092. doi:10.1056/NEJMoa1801005
  5. Garon EB, Rizvi NA, Hui R, et al. Pembrolizumab for the treatment of non-small-cell lung cancer. N Engl J Med. 2015;372(21):2018-2028. doi: 10.1056/NEJMoa1501824
  6. Choueiri TK, Motzer RJ. Systemic therapy for metastatic renal-cell carcinoma. N Engl J Med. 2017;376(4):354-366. doi:10.1056/NEJMra1601 333
  7. Foerster F, Gairing SJ, Ilyas SI, Galle PR. Emerging immunotherapy for HCC: a guide for hepatologists. Hepatology. 2022;75(6):1604-1626. doi: 10.1002/hep.32447
  8. Rizzo A, Cantale O, Mogavero A, et al. Assessing the role of colonic and other anatomical sites uptake by [18F]FDG-PET/CT and immune-inflammatory peripheral blood indexes in patients with advanced non-small cell lung cancer treated with first-line immune checkpoint inhibitors. Thorac Cancer. 2023;14(24):2473-2483. doi:10.1111/1759-7714.15032
  9. Liu J, Li S, Zhang S, et al. Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio can predict clinical outcomes in patients with metastatic non-small-cell lung cancer treated with nivolumab. J Clin Lab Anal. 2019;33(8):e22964. doi:10.1002/jcla.22964
  10. He Y, Wang X. Identifying biomarkers associated with immunotherapy response in melanoma by multi-omics analysis. Comput Biol Med. 2023; 167:107591. doi:10.1016/j.compbiomed.2023.107591
  11. Cvetkovic L, Régis C, Richard C, et al. Physiologic colonic uptake of 18F-FDG on PET/CT is associated with clinical response and gut microbiome composition in patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors. Eur J Nucl Med Mol Imaging. 2021;48(5):1550-1559. doi:10.1007/s00259-020-05081-6
  12. Boursi B, Werner TJ, Gholami S, et al. Physiologic colonic fluorine-18-fluorodeoxyglucose uptake may predict response to immunotherapy in patients with metastatic melanoma. Melanoma Res. 2019;29(3):318-321. doi:10.1097/CMR.0000000000000566
  13. Levi J, Das M, Vasanawala MS, et al. [18F]F-AraG uptake in vertebral bone marrow may predict survival in patients with non-small cell lung cancer treated with anti-PD-(L)1 immunotherapy. J Nucl Med. 2024; 65(12):1869-1875. doi:10.2967/jnumed.124.268253
  14. Ito K, Schöder H, Teng R, et al. Prognostic value of baseline metabolic tumor volume measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography in melanoma patients treated with ipilimumab therapy. Eur J Nucl Med Mol Imaging. 2019;46(4):930-939. doi:10.1007/s00259-018-4211-0
  15. Nakamoto R, Zaba LC, Rosenberg J, et al. Prognostic value of volumetric PET parameters at early response evaluation in melanoma patients treated with immunotherapy. Eur J Nucl Med Mol Imaging. 2020;47(12):2787-2795. doi:10.1007/s00259-020-04792-0
  16. Limagne E, Euvrard R, Thibaudin M, et al. Accumulation of MDSC and Th17 cells in patients with metastatic colorectal cancer predicts the efficacy of a FOLFOX-bevacizumab drug treatment regimen. Cancer Res. 2016;76(18):5241-5252. doi:10.1158/0008-5472.can-15-3164
  17. Khaled YS, Ammori BJ, Elkord E. Increased levels of granulocytic myeloid-derived suppressor cells in peripheral blood and tumour tissue of pancreatic cancer patients. J Immunol Res. 2014;2014:879897. doi:10. 1155/2014/879897
  18. Ji C, Roy MD, Golas J, et al. Myocarditis in cynomolgus monkeys following treatment with immune checkpoint inhibitors. Clin Cancer Res. 2019;25(15):4735-4748. doi:10.1158/1078-0432.CCR-18-4083
  19. Oliveira Taveira M, de Barros E Silva MJ, Vieira Barbosa Pinto PN. Imaging-calculated splenic volume is associated with response in melanoma patients treated with immunotherapy. Immunotherapy. 2023;15(5):343-351. doi:10.2217/imt-2022-0222
  20. Susok L, Reinert D, Lukas C, Stockfleth E, Gambichler T. Volume increase of spleen in melanoma patients undergoing immune checkpoint blockade. Immunotherapy. 2021;13(11):885-891. doi:10.2217/imt-2021-0022
  21. Aktaş GE, Sarıkaya A, Demir SS. Diffusely increased splenic fluorodeoxyglucose uptake in lung cancer patients. Turk Thorac J. 2017;18(1):6-10. doi:10.5152/TurkThoracJ.2017.16025
  22. Nam HY, Kim SJ, Kim IJ, Kim BS, Pak K, Kim K. The clinical implication and prediction of diffuse splenic FDG uptake during cancer surveillance. Clin Nucl Med. 2010;35(10):759-763. doi:10.1097/RLU.0b013e3181ef0905
  23. Sachpekidis C, Stein-Thoeringer CK, Kopp-Schneider A, Weru V, Dimitrakopoulou-Strauss A, Hassel JC. Can physiologic colonic [18F]FDG uptake in PET/CT imaging predict response to immunotherapy in metastatic melanoma? Eur J Nucl Med Mol Imaging. 2023;50:3709-3722.
  24. Wang L, Zhang S, Xin J. Predicting diffuse large B-cell lymphoma outcomes with lesion-to-liver maximum standardized uptake value for interim-treatment and end-of-treatment positron emission tomography-computed tomography. Quant Imaging Med Surg. 2023;13(10): 6789-6800. doi:10.21037/qims-23-251
  25. Kim SY, Moon CM, Yoon HJ, et al. Diffuse splenic FDG uptake is predictive of clinical outcomes in patients with rectal cancer. Sci Rep. 2019;9(1):1313. doi:10.1038/s41598-018-35912-4
  26. Seban RD, Nemer JS, Marabelle A, et al. Prognostic and theranostic 18F-FDG PET biomarkers for anti-PD1 immunotherapy in metastatic melanoma: association with outcome and transcriptomics. Eur J Nucl Med Mol Imaging. 2019;46(11):2298-2310. doi:10.1007/s00259-019-04411-7
  27. Mo Z, Lv L, Mai Q, et al. Prognostic model for unresectable hepatocellular carcinoma treated with dual PD-1 and angiogenesis blockade therapy. J Immunother Cancer. 2024;12(1):e008191. doi:10.1136/jitc-2023-008191
  28. Aslan V, Karabörk Kılıç AC, Özet A, et al. The role of spleen volume change in predicting immunotherapy response in metastatic renal cell carcinoma. BMC Cancer. 2023;23(1):1045. doi:10.1186/s12885-023-11558-y
  29. Castagnoli F, Doran S, Lunn J, et al. Splenic volume as a predictor of treatment response in patients with non-small cell lung cancer receiving immunotherapy. PLoS One. 2022;17(7):e0270950. doi:10.1371/journal.pone.0270950
  30. Yang SH, Lu LC, Kao HF, et al. Negative prognostic implications of splenomegaly in nivolumab-treated advanced or recurrent pancreatic adenocarcinoma. Oncoimmunology. 2021;10(1):1973710. doi:10.1080/2162402X.2021.1973710
  31. Duwe G, Müller L, Ruckes C, et al. Change in splenic volume as a surrogate marker for immunotherapy response in patients with advanced urothelial and renal cell carcinoma-evaluation of a novel approach of fully automated artificial intelligence based splenic segmentation. Biomedicines. 2023;11(9):2482. doi:10.3390/biomedicines11092482
  32. Galland L, Lecuelle J, Favier L, et al. Splenic volume as a surrogate marker of immune checkpoint inhibitor efficacy in metastatic non-small cell lung cancer. Cancers (Basel). 2021;13(12):3020. doi:10.3390/cancers13123020
  33. Müller L, Gairing SJ, Kloeckner R, et al. Baseline splenic volume outweighs immuno-modulated size changes with regard to survival outcome in patients with hepatocellular carcinoma under immunotherapy. Cancers (Basel). 2022;14(15):3574. doi:10.3390/cancers 14153574
  34. Chen BB, Liang PC, Shih TT, et al. Changes in posttreatment spleen volume associated with immunotherapy outcomes for advanced hepatocellular carcinoma. J Hepatocell Carcinoma. 2024;11:1015-1029. doi:10.2147/JHC.S462470
  35. Li Y, Guo L, Xie P, et al. Systemic immune-related spleen radiomics predict progression-free survival in patients with locally advanced cervical cancer underwent definitive chemoradiotherapy. BMC Med Imaging. 2024;24(1):310. doi:10.1186/s12880-024-01492-1
  36. Seban RD, Moya-Plana A, Antonios L, et al. Prognostic 18F-FDG PET biomarkers in metastatic mucosal and cutaneous melanoma treated with immune checkpoint inhibitors targeting PD-1 and CTLA-4. Eur J Nucl Med Mol Imaging. 2020;47(10):2301-2312. doi:10.1007/s00259-020-04757-3
  37. Seban RD, Assié JB, Giroux-Leprieur E, et al. Prognostic value of inflammatory response biomarkers using peripheral blood and [18F]-FDG PET/CT in advanced NSCLC patients treated with first-line chemo- or immunotherapy. Lung Cancer. 2021;159:45-55. doi:10.1016/j.lungcan.2021.06.024
  38. Kwon HR, Cho J, Park S, et al. Metabolic parameters on baseline 18F-FDG PET/CT are potential predictive biomarkers for immunotherapy in patients with head and neck squamous cell carcinoma. Front Med (Lausanne). 2022;9:896494. doi:10.3389/fmed.2022.896494
  39. Yoon HJ, Kim BS, Moon CM, Yoo J, Lee KE, Kim Y. Prognostic value of diffuse splenic FDG uptake on PET/CT in patients with gastric cancer. PLoS One. 2018;13(4):e0196110. doi:10.1371/journal.pone.0196110
  40. Wong A, Callahan J, Keyaerts M, et al. 18F-FDG PET/CT based spleen to liver ratio associates with clinical outcome to ipilimumab in patients with metastatic melanoma. Cancer Imaging. 2020;20(1):36. doi:10.1186/s 40644-020-00313-2
  41. Zhao Z, Zhou Y, Yao X, et al. Prognostic significance of diffuse increased fluorine-18-fluorodeoxyglucose (18F-FDG) uptake within the reticuloendothelial system in lymphoma patients. Quant Imaging Med Surg. 2024;14(9):6374-6385. doi:10.21037/qims-24-180