PreprintCC BY-NC-NDbioRxiv10 Sep 2026

Amygdala metabolic activity on FDG PET is associated with survival, response to immune checkpoint inhibition, and tumor immune signaling in non-small cell lung cancer

B. K. Geist
C. Vraka
C. T. S. Mertel
L. Beer
A. Frille
L. Herbsthofer
N. Hermann
S. Hesse
L. Kenner
D. Kifjak
K. Kluge
O. C. Kulterer

18 more authors

C. Lapa
A. Lieblich
T. S. Nakuz
F. Oberndorfer
R. Kain
H. Prosch
O. Sabri
B. Sattler
T. Schweiger
C. Aigner
C. Spielvogel
D. Tsomaia
K. Trachtova
M. Tomberger
H. Wirtz
J. Yu
S. Grünert
M. Hacker¹

¹Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna

Abstract

Amygdala metabolic activity (AmygAc) measured by [18F]FDG PET has been associated with chronic psychological stress and adverse clinical outcomes, but its relationship with antitumor immunity and treatment response remains incompletely understood. We investigated AmygAc as a host-derived imaging biomarker in non-small cell lung cancer (NSCLC) and examined its association with survival, response to immune checkpoint inhibition (ICI), and the tumor immune microenvironment. Methods: In this multicenter retrospective study, baseline [18F]FDG PET scans from 256 treatment-naive patients with NSCLC were analyzed to quantify AmygAc. Overall survival was assessed in the full cohort, and treatment response was evaluated in 79 patients who subsequently received neoadjuvant ICI therapy. AmygAc was integrated with clinical and tumor-derived imaging parameters. To investigate its biological correlates, tumor tissue from a selected subcohort was analyzed using multiplex immunofluorescence and spatial transcriptomics.

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BibTeX

@misc{geist2026amygdala,
  title = {{Amygdala metabolic activity on FDG PET is associated with survival, response to immune checkpoint inhibition, and tumor immune signaling in non-small cell lung cancer}},
  author = {B. K. Geist and C. Vraka and C. T. S. Mertel and L. Beer and A. Frille and L. Herbsthofer and N. Hermann and S. Hesse and L. Kenner and D. Kifjak and K. Kluge and O. C. Kulterer and C. Lapa and A. Lieblich and T. S. Nakuz and F. Oberndorfer and R. Kain and H. Prosch and O. Sabri and B. Sattler and T. Schweiger and C. Aigner and C. Spielvogel and D. Tsomaia and K. Trachtova and M. Tomberger and H. Wirtz and J. Yu and S. Grünert and M. Hacker},
  howpublished = {bioRxiv},
  year = {2026},
  month = sep,
  doi = {10.64898/2026.09.10.750685},
  url = {https://www.biorxiv.org/content/10.64898/2026.09.10.750685v1},
  note = {CC BY-NC-ND},
}

RIS

TY  - UNPB
TI  - Amygdala metabolic activity on FDG PET is associated with survival, response to immune checkpoint inhibition, and tumor immune signaling in non-small cell lung cancer
AU  - B. K. Geist
AU  - C. Vraka
AU  - C. T. S. Mertel
AU  - L. Beer
AU  - A. Frille
AU  - L. Herbsthofer
AU  - N. Hermann
AU  - S. Hesse
AU  - L. Kenner
AU  - D. Kifjak
AU  - K. Kluge
AU  - O. C. Kulterer
AU  - C. Lapa
AU  - A. Lieblich
AU  - T. S. Nakuz
AU  - F. Oberndorfer
AU  - R. Kain
AU  - H. Prosch
AU  - O. Sabri
AU  - B. Sattler
AU  - T. Schweiger
AU  - C. Aigner
AU  - C. Spielvogel
AU  - D. Tsomaia
AU  - K. Trachtova
AU  - M. Tomberger
AU  - H. Wirtz
AU  - J. Yu
AU  - S. Grünert
AU  - M. Hacker
PY  - 2026
DA  - 2026/09/10
PB  - bioRxiv
DO  - 10.64898/2026.09.10.750685
UR  - https://www.biorxiv.org/content/10.64898/2026.09.10.750685v1
AB  - Amygdala metabolic activity (AmygAc) measured by [18F]FDG PET has been associated with chronic psychological stress and adverse clinical outcomes, but its relationship with antitumor immunity and treatment response remains incompletely understood. We investigated AmygAc as a host-derived imaging biomarker in non-small cell lung cancer (NSCLC) and examined its association with survival, response to immune checkpoint inhibition (ICI), and the tumor immune microenvironment. Methods: In this multicenter retrospective study, baseline [18F]FDG PET scans from 256 treatment-naive patients with NSCLC were analyzed to quantify AmygAc. Overall survival was assessed in the full cohort, and treatment response was evaluated in 79 patients who subsequently received neoadjuvant ICI therapy. AmygAc was integrated with clinical and tumor-derived imaging parameters. To investigate its biological correlates, tumor tissue from a selected subcohort was analyzed using multiplex immunofluorescence and spatial transcriptomics.
ER  -

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