Prognostic parameters on baseline and interim [18F]FDG-PET/computed tomography in diffuse large B-cell lymphoma patients. Issue 4 (30th April 2023)

• Record Type: Journal Article
• Authors: Czibor, Sándor; Carr, Robert; Redondo, Francisca; Auewarakul, Chirayu U.; Cerci, Juliano J.; Paez, Diana; Fanti, Stefano; Györke, Tamás
• Is Part Of: Nuclear medicine communications. Volume 44:Issue 4(2023)
• Page Start: 291
• Page End: 301
• Publication Date: 2023-04-30
• Subjects: diffuse large B-cell lymphoma -- Deauville score -- PET -- metabolic tumor volume -- ratio PET; Nuclear medicine -- Periodicals; 616.07575
• DOI: 10.1097/MNM.0000000000001664
• Languages: English
• ISSNs: 0143-3636

Abstract

Abstract : Objective: 2-[ 18 F]fluoro-2-deoxy-d -glucose PET/computed tomography ([ 18 F]FDG-PET/CT) is a widely used imaging method in the management of diffuse large B-cell lymphomas (DLBCL). Our aim was to investigate the prognostic performance of different PET biomarkers in a multicenter setting. Methods: We investigated baseline volumetric values [metabolic tumor volume (MTV) and total lesion glycolysis (TLG), also normalized for body weight] segmented with three different methods [>SUV4 (glob4); 41% isocontour (41pc), and a gradient-based lesion growing algorithm (grad)] and interim parameters [Deauville score, maximal standardized uptake value (ΔSUVmax), modified qPET, and ratio PET (rPET)] alongside clinical parameters (stage, revised International Prognostic Index), using 24-month progression-free survival as the clinical endpoint. Receiver operating characteristics analyses were performed to define optimal cutoff points for the continuous PET parameters. Results: A total of 107 diffuse large B-cell lymphoma patients were included (54 women; mean age: 53.7 years). MTV and TLG calculations showed good correlation among glob4, 41pc, and grad methods; however, optimal cutoff points were markedly different. Significantly different PFS was observed between low- and high-risk groups according to baseline MTV, body weight-adjusted (bwa) MTV, TLG, bwaTLG, as well as interim parameters Deauville score, ΔSUVmax, mqPET, and rPET. Univariate Cox regression analyses showed hazard ratios (HRs) lowest for bwaMTVglob4 (HR = 2.3) and highest for rPET (HR = 9.09). In a multivariate Cox-regression model, rPET was shown to be an independent predictor of PFS ( P = 0.041; HR = 9.15). Combined analysis showed that ΔSUVmax positive patients with high MTV formed a group with distinctly poor PFS (35.3%). Conclusion: Baseline MTV and TLG values and optimal cutoff points achieved with different segmentation methods varied markedly and showed a limited prognostic impact. Interim PET/CT parameters provided more accurate prognostic information with semiquantitative 'Deauville-like' parameters performing best in the present study.