Relationship between the expression of PD-1/PD-L1 and 18F-FDG uptake in bladder cancer

  • Ruohua Chen
  • Xiang Zhou
  • Jianjun Liu
  • Gang Huang
Original Article



Immunotherapy aimed at inhibiting the PD-1/PD-L1 immune checkpoint has been approved and used successfully for the treatment of bladder cancer. The identification of markers predictive of response to immune checkpoint inhibitors is critical to advancing the success of this therapy. 18F-FDG PET/CT is a molecular imaging technique that can provide phenotypic information on malignant tumours. It is currently unknown whether there is a relationship between 18F-FDG uptake and expression of PD-1/PD-L1 in bladder cancer. In this study, we investigated whether PD-1/PD-L1 expression is associated with 18F-FDG uptake in bladder cancer, and whether 18F-FDG PET/CT imaging can be used to predict the PD-1/PD-L1 status of bladder cancer.


A retrospective analysis was performed in 63 patients with bladder cancer who had undergone 18F-FDG PET/CT before surgical resection. Maximum standardized uptake values (SUVmax) were determined.


SUVmax was significantly higher in PD-1-positive patients than in PD-1-negative patients (33.0 ± 13.9 and 19.6 ± 14.2, respectively; P = 0.032), and in PD-L1-positive patients than in PD-L1-negative patients (29.1 ± 15.6 and 15.8 ± 11.4, respectively; P < 0.0001). In a multivariate analysis SUVmax was significantly associated with both PD-1 expression and PD-L1 expression (P = 0.021 and P = 0.003, respectively). Using a SUVmax cut-off value of 22.7, PD-1 status and PD-L1 status could be predicted with accuracies of 71.4% and 77.8%, respectively.


Higher 18F-FDG uptake by bladder cancer is associated with elevated PD-1/PD-L1 expression. 18F-FDG PET/CT may be useful for predicting the PD-1/PD-L1 status of bladder cancer and for determining the optimal therapeutic strategy.


Bladder cancer PD-1 PD-L1 PET/CT SUVmax 



This work was supported by grants from the National Natural Science Foundation of China (Nos. 30830038, 30970842, 81071180, 81471687, 81572719, 81571710, 81601520, 81601536, 81602415, 81701724, 81701725, 81771858, 81830052, 81530053), the Major State Basic Research Development Program of China (973 program; no. 2012CB932604), and the New Drug Discovery Project (no. 2012ZX09506-001-005).

Compliance with ethical standards

Conflicts of interest


Ethical approval

All procedures performed in studies involving human participants were approved by the Institutional Review Board of Shanghai Jiao Tong University-affiliated Ren Ji Hospital and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not describe any studies with animals performed by any of the authors.

Informed consent

Informed consent was waived for the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nuclear Medicine, Ren Ji Hospital, School of MedicineShanghai Jiao Tong UniversityShanghaiChina
  2. 2.Shanghai University of Medicine & Health SciencesShanghaiChina

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