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Prognostic value of metabolic tumour volume on baseline 18F-FDG PET/CT in addition to NCCN-IPI in patients with diffuse large B-cell lymphoma: further stratification of the group with a high-risk NCCN-IPI

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Abstract

Purpose

The purpose of this study was to determine the prognostic value of metabolic volumetric parameters as a quantitative index on pre-treatment 18F-FDG PET/CT in addition to the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) in patients with diffuse large B-cell lymphoma (DLBCL).

Methods

A total of 103 consecutive patients with DLBCL and baseline FDG PET/CT were retrospectively evaluated. Quantitative metabolic parameters, including total metabolic tumour volume (TMTV) using a standardized uptake value (SUV) of ≥2.5 as the threshold, were estimated. Receiver operating characteristic curve analysis was used to determine the optimal cut-off values for the metabolic parameters. The relationships between study variables and patient survival were tested using Cox regression analysis. Patient survival rates were derived from Kaplan-Meier curves and compared using the log-rank test.

Results

Median follow-up was 34 months. In patients with a low TMTV (<249 cm3), the 3-year progression free survival (PFS) rate was 83% and the overall survival (OS) rate was 92%, in contrast to 41% and 57%, respectively, in those with a high TMTV (≥249 cm3). In univariate analysis, a high TMTV and NCCN-IPI ≥4 were associated with inferior PFS and OS (P < 0.0001 for all), as was a high total lesion glycolysis (P = 0.004 and P = 0.005, respectively). In multivariate analysis, TMTV and NCCN-IPI were independent predictors of PFS (hazard ratio, HR, 3.11, 95% confidence interval, CI, 1.37–7.07, P = 0.007, and HR 3.42, 95% CI 1.36–8.59, P = 0.009, respectively) and OS (HR 3.41, 95% CI 1.24–9.38, P = 0.017, and HR 5.06, 95% CI 1.46–17.60, P = 0.014, respectively). TMTV was able to separate patients with a high-risk NCCN-IPI of ≥4 (n = 62) into two groups with significantly different outcomes; patients with low TMTV (n = 16) had a 3-year PFS rate of 75% and an OS rate of 88%, while those with a high TMTV had a 3-year PFS rate of 32% and an OS rate of 47% (χ2 = 7.92, P = 0.005, and χ2 = 8.26, P = 0.004, respectively). However, regardless of TMTV, patients with a low-risk NCCN-IPI of <4 (n = 41) had excellent outcomes (3-year PFS and OS rates of 85% and 95%, respectively).

Conclusion

Pretreatment TMTV was an independent predictor of survival in patients with DLBCL. Importantly, TMTV had an additive prognostic value in patients with a high-risk NCCN-IPI. Thus, the combination of baseline TMTV with NCCN-IPI may improve the prognostication and may be helpful guide the decision for intensive therapy and clinical trials, especially in DLBCL patients with a high-risk NCCN-IPI.

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Acknowledgments

This work was supported by an intramural research program of Seoul National University College of Medicine and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HI14C1072 & H18C1916).

Funding

This study was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (no. 2012R1A2A1A01010846) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HI14C1072 & H18C1916).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Seoul National University, College of Medicine, Daehangro 101, Jongno-gu, Seoul, 03080, South Korea

    Qaid Ahmed Shagera, Gi Jeong Cheon, Min Young Yoo, Keon Wook Kang, Dong Soo Lee, E. Edmund Kim & June-Key Chung

  2. Department of Nuclear Medicine, Althawrah Modern General Hospital, Sana’a, Yemen

    Qaid Ahmed Shagera

  3. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea

    Gi Jeong Cheon, Keon Wook Kang, Dong Soo Lee & June-Key Chung

  4. Cancer Research Institute and Radiation Medicine Institute, Seoul National University, Seoul, South Korea

    Gi Jeong Cheon, Youngil Koh, Keon Wook Kang, Sung-Soo Yoon & June-Key Chung

  5. Division of Hematology/Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Youngil Koh & Sung-Soo Yoon

  6. Department of Nuclear Medicine, Chungbuk National University Hospital, Cheongju, South Korea

    Min Young Yoo

  7. Department of Radiological Sciences, University of California, Irvine, CA, USA

    E. Edmund Kim

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  1. Qaid Ahmed Shagera
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Correspondence to Gi Jeong Cheon.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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This retrospective study was approved by the institutional review board. The requirement for written informed consent was waived due to the retrospective design of the study.

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Shagera, Q.A., Cheon, G.J., Koh, Y. et al. Prognostic value of metabolic tumour volume on baseline 18F-FDG PET/CT in addition to NCCN-IPI in patients with diffuse large B-cell lymphoma: further stratification of the group with a high-risk NCCN-IPI. Eur J Nucl Med Mol Imaging 46, 1417–1427 (2019). https://doi.org/10.1007/s00259-019-04309-4

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