Despite the systemic impact of both cancer and the associated immune response, immuno-PET is predominantly centered on assessment of the immune milieu within the tumor microenvironment. The aim of this study was to assess the value of [¹⁸F]F-AraG PET imaging as a noninvasive method for evaluation of system-wide immune status of patients with non–small cell lung cancer before starting immunotherapy. Methods: Eleven patients with advanced non–small cell lung cancer were imaged with [¹⁸F]F-AraG before starting immunotherapy. Diagnostic [¹⁸F]FDG PET/CT scans were analyzed to assess differences in the extent of disease among patients. SUV_max, SUV_mean, and total SUV (SUV_total) from all tumor lesions, active lymph nodes, spleen, vertebral bone marrow, liver, thyroid, heart, and bowel were extracted from the baseline [¹⁸F]F-AraG scans, and discriminant and Kaplan–Meier analyses were performed to test their ability to predict patient response and overall survival. Results: The extent of the disease was variable in the patient cohort, but none of the [¹⁸F]FDG biomarkers associated with tumor burden (SUV_max, total metabolic tumor volume, and total lesion glycolysis) was predictive of patient survival. The differences in the [¹⁸F]F-AraG and [¹⁸F]FDG distribution were observed both within and between lesions, confirming that they capture distinct aspects of the tumor microenvironment. Of the 3 SUV parameters studied, [¹⁸F]F-AraG SUV_total provided a dynamic range suitable for stratifying tumors or patients according to their immune activity. [¹⁸F]F-AraG SUV_total measured in the lumbar and sacral vertebrae differentiated between patients who progressed on therapy and those who did not with 90.9% and 81.8% accuracy, respectively. The Kaplan–Meier analysis revealed that patients with high [¹⁸F]F-AraG SUV_total in the lumbar bone marrow had significantly lower probability of survival than those with a low signal (P = 0.0003). Conclusion: This study highlights the significance of assessing systemic immunity and indicates the potential of the [¹⁸F]F-AraG bone marrow signal as a predictive imaging biomarker for patient stratification and treatment guidance.

尽管癌症和相关免疫反应都有全身影响，但 immuno-PET 主要集中在评估肿瘤微环境中的免疫环境。本研究的目的是评估 [¹⁸F]F-AraG PET 成像作为一种无创方法在开始免疫治疗前评估非小细胞肺癌患者全系统免疫状态的价值。方法：11 例晚期非小细胞肺癌患者在开始免疫治疗前用 [¹⁸F]F-AraG 成像。分析诊断性 [¹⁸F]FDG PET/CT 扫描以评估患者之间疾病程度的差异。从基线 [18 F]F-AraG 扫描中提取所有肿瘤病灶、活动性淋巴结、脾脏、椎骨髓、肝脏、甲状腺、心脏和肠道的 SUV_max、SUV_平均值和总 SUV （SUV_total） [¹⁸F]F-AraG 扫描，并进行判别分析和 Kaplan-Meier 分析以测试它们预测患者反应和总生存期的能力。结果：疾病的程度在患者队列中是可变的，但与肿瘤负荷相关的 [¹⁸F]FDG 生物标志物 （SUV_max、总代谢肿瘤体积和总病变糖酵解） 均不能预测患者生存。在病灶内和病灶之间观察到 [¹⁸F]F-AraG 和 [¹⁸F]FDG 分布的差异，证实它们捕获了肿瘤微环境的不同方面。在研究的 3 个 SUV 参数中，[¹⁸F]F-AraG SUV_total 提供了一个适合根据免疫活动对肿瘤或患者进行分层的动态范围。 [¹⁸个地址]在腰椎和骶椎中测量的 F-AraG SUV_总数区分了治疗进展的患者和未治疗进展的患者，准确率分别为 90.9% 和 81.8%。Kaplan-Meier 分析显示，腰骨髓中 [¹⁸F]F-AraG SUV_总数高的患者生存概率显著低于信号低的患者 （P = 0.0003）。结论：这项研究强调了评估全身免疫的重要性，并表明了 [¹⁸F]F-AraG 骨髓信号作为患者分层和治疗指导的预测性成像生物标志物的潜力。