Prognostic superiority of the National Comprehensive Cancer Network International Prognostic Index over pretreatment whole-body volumetric-metabolic FDG-PET/CT metrics in diffuse large B-cell lymphoma

Hugo J A Adams; John M H de Klerk; Rob Fijnheer; Ben G F Heggelman; Stefan V Dubois; Rutger A J Nievelstein; Thomas C Kwee

doi:10.1111/ejh.12467

Prognostic superiority of the National Comprehensive Cancer Network International Prognostic Index over pretreatment whole-body volumetric-metabolic FDG-PET/CT metrics in diffuse large B-cell lymphoma

Eur J Haematol. 2015 Jun;94(6):532-9. doi: 10.1111/ejh.12467. Epub 2015 Mar 13.

Authors

Hugo J A Adams¹, John M H de Klerk², Rob Fijnheer³, Ben G F Heggelman⁴, Stefan V Dubois⁵, Rutger A J Nievelstein¹, Thomas C Kwee¹

Affiliations

¹ Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
² Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands.
³ Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands.
⁴ Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands.
⁵ Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands.

PMID: 25311082
DOI: 10.1111/ejh.12467

Abstract

Purpose: This study aimed to determine the prognostic value of whole-body maximum standardized uptake value (SUVmax ), whole-body metabolic tumor volume (MTV), and whole-body total lesion glycolysis (TLG) at pretreatment (18) F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).

Materials and methods: Seventy-three patients with newly diagnosed DLBCL who had undergone FDG-PET/CT before rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone (R-CHOP) immunochemotherapy were retrospectively included. All FDG-avid lesions in each patient were segmented using semi-automated software to calculate whole-body SUVmax , whole-body MTV, and whole-body TLG values. Cox regression analyses were used to determine the associations of whole-body SUVmax , whole-body MTV, whole-body TLG, and dichotomized National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) risk group (low risk vs. high risk) with progression-free survival (PFS) and overall survival (OS).

Results: On univariate Cox regression analysis, only the NCCN-IPI was a significant predictor of PFS (P = 0.024), and only the NCCN-IPI and whole-body MTV were significant predictors of OS (P = 0.039 and P = 0.043, respectively). In the multivariate Cox proportional hazards model, only the NCCN-IPI remained an independent predictive factor of PFS (P = 0.024) and OS (P = 0.039).

Conclusion: Whole-body SUVmax , whole-body MTV, and whole-body TLG do not provide any prognostic information in DLBCL beyond that which can already be obtained by the NCCN-IPI. Therefore, the NCCN-IPI remains the most important prognostic tool in this disease.

Keywords: 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography; National Comprehensive Cancer Network International Prognostic Index; diffuse large B-cell lymphoma; prognosis; survival; total lesion glycolysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Female
Fluorodeoxyglucose F18*
Follow-Up Studies
Glycolysis
Humans
Image Processing, Computer-Assisted
Kaplan-Meier Estimate
Lymphoma, Large B-Cell, Diffuse / diagnosis*
Lymphoma, Large B-Cell, Diffuse / mortality
Lymphoma, Large B-Cell, Diffuse / therapy
Male
Middle Aged
Positron-Emission Tomography*
Prognosis
Proportional Hazards Models
Retrospective Studies
Tomography, X-Ray Computed*
Tumor Burden
Whole Body Imaging*

Substances

Fluorodeoxyglucose F18