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.


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*


  • Fluorodeoxyglucose F18