{
  "abstract": "Introduction: Programmed death-ligand 1 (PD-L1) expression was different in primary tumors (PT) and metastatic tumors (MT). Total-body positron-emission tomography/computed tomography (PET/CT) comprehensively visualizes primary lesions and metastases. We aimed to explore the heterogeneity of PD-L1 high expression and metabolic activity between primary and metastatic lesions in patients with non-small cell lung cancer (NSCLC).\n\nMethods: Immunohistochemistry analysis (IHC) was conducted for PD-L1 expression on tumor cells (TC) and tumor-infiltrating immune cells (IC) with 22C3 antibody. PD-L1 positive scores on TC no less than 50% or IC no less than 10% was defined as high expression. Total 598 (456 adenocarcinoma (ADC) and 142 squamous cell lung carcinoma (SCC)) primary diagnosed NSCLC patients who underwent ¹⁸ F-FDG-PET/CT imaging were collected retrospectively. The statistic methods included chi-square test, Mann Whitney test and multivariate regression.\n\nResults: 598 patients included 441 with PD-L1 low expression and 157 high expression. In all subtypes and ADC, MT had higher PD-L1 high expression (P = 0.023 and P = 0.010, respectively). The maximum standard uptake value (SUVmax) of PD-L1 high expression was significantly higher than that of PD-L1 low expression, no matter in PT or MT (15.23 (8.85) vs 9.42 (8.34), P<0.001; 13.36 (5.55) vs 8.52 (6.93), P<0.001). The squamous-cell-carcinoma metastatic-lesion analyses were exploratory owing to the very small sample size and risk of type-II statistical error. Multivariate regression indicated that SUVmax was independently associated with PD-L1 high expression. In all metastatic sites, we compared the SUVmax of MT and paired PT and found SUVmax was higher in PT than MT in PD-L1 low expression subgroup (11.39 (8.12) vs 8.52 (6.93), P = 0.002). For lymph node metastases, SUVmax was significantly elevated in PT compared to MT in PD-L1 low expression (13.71 (7.95) vs 8.54 (7.30), P = 0.002), whereas no correlation was observed in PD-L1 high expression.\n\nDiscussion: Both PD-L1 expression and metabolism exhibited heterogeneity between primary tumors and their metastases. Compared to the primary tumors, different types of metastatic tumors showed variations not only in PD-L1 expression but also in their metabolic parameter. Utilizing whole-body PET/CT imaging facilitates the selection of optimal biopsy sites by providing metabolic reference data pertinent to clinical practice.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Nuclear Medicine of Henan Provincial People’s Hospital & the People’s Hospital of Zhengzhou University",
    "Henan Key Laboratory of Novel Molecular Probes and Clinical Translation in Nuclear Medicine"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Bingxin Hu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Huibin Jin"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yue Yu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jie Zhang"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yang You"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Chang Fu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Ang Xuan"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xinyu Wu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yongju Gao"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/49nfkkqp7xzt1.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1966803",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13709988/",
  "id": "49nfkkqp7xzt1",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1966803/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2730|Cancer Immunotherapy and Biomarkers"
    ]
  ],
  "openalex": "W7221727644",
  "pdf_url": "https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1966803/pdf",
  "pmcid": "PMC13709988",
  "pmid": "42947673",
  "published": "2026-10-13",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/49nfkkqp7xzt1.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:13Z",
      "native_id": "10.3389/fonc.2026.1966803",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1966803/full"
    },
    {
      "first_seen": "2026-10-31T12:21:02Z",
      "native_id": "PMC13709988",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fonc.2026.1966803"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Cancer Immunotherapy and Biomarkers",
      "subfield": "oncology"
    }
  ],
  "title": "Unveiling the heterogeneity: PD-L1 expression and metabolic activity in primary vs. metastatic NSCLC, a retrospective single-center analysis",
  "title_text": "Unveiling the heterogeneity: PD-L1 expression and metabolic activity in primary vs. metastatic NSCLC, a retrospective single-center analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:21:02Z",
  "url": "https://research.draconitic.com/paper/49nfkkqp7xzt1",
  "venue": "Frontiers in Oncology",
  "versions": []
}