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Prediction nomogram based on 18F-FDG PET/CT and clinical parameters for patients with diffuse large B-cell lymphoma

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Abstract

The objective of this study was to develop a nomogram including parameters assessed by 18F-FDG PET/CT and clinical parameters for patients with diffuse large B-cell lymphoma (DLBCL) to predict progression-free survival (PFS). A total of 181 patients with pathologically diagnosed DLBCL at Sichuan Cancer Hospital and Institute from March 2015 to December 2020 were enrolled in this retrospective study. The area under the receiver operating characteristic (ROC) curve (AUC) was used to calculate the optimal cutoff values of the semiquantitative parameters (SUVmax, TLG, MTV, and Dmax) for PFS. A nomogram was constructed according to multivariate Cox proportional hazards regression. The predictive and discriminatory capacities of the nomogram were then measured using the concordance index (C-index), calibration plots, and Kaplan–Meier curves. The predictive and discriminatory capacities of the nomogram and the International Prognostic Index of the National Comprehensive Cancer Network (NCCN-IPI) were compared via the C-index and AUC. Multivariate analysis demonstrated that male gender and pretreatment Ann Arbor stage III-IV, non-GCB, elevated lactate dehydrogenase (LDH), number of extranodal organ involvement (Neo)>1, MTV≥152.8 cm3, and Dmax ≥53.9 cm were associated with unfavorable PFS (all p<0.05). The nomogram, including gender, Ann Arbor stage, pathology type, Neo, LDH levels, MTV, and Dmax, showed good prediction accuracy, with a C-index of 0.760 (95% CI: 0.727–0.793), which was higher than that of NCCN-IPI (0.710; 95% CI: 0.669–751). The calibration plots for 2-year demonstrated good consistency between the predicted and observed probabilities for survival time. We established a nomogram including MTV, Dmax, and several clinical parameters to predict the PFS of patients with DLBCL, and the nomogram showed better predictability and higher accuracy than NCCN-IPI.

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Funding

This work was supported by the Science and Technology Program of Sichuan Province (Grant No.22DYF2372); Science and Technology Program of Sichuan Province (Grant No.2020YFS0417); Sichuan Medical Research Project (Grant No. S21030); Sichuan Cancer Hospital Outstanding Youth Funding (Grant No. YB2021029); and Wu Jieping Medical Foundation Clinical Research Special Fund Project (Grant No.320.6750.19094-36).

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Authors and Affiliations

  1. Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China

    Xiaojuan Peng, Sisi Yu, Ying Kou, Jun Dang, Ping Wu, Yutang Yao, Jiaqi Shen, Yongli Liu, Xiaoxiong Wang & Zhuzhong Cheng

  2. North Sichuan Medical College, Nanchong, China

    Xiaojuan Peng & Jun Dang

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  1. Xiaojuan Peng
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Contributions

All authors contributed to the study’s conception and design. Material preparation and data collection were performed by Xiaojuan Peng, Jun Dang, Xiaoxiong Wang, and Yongli Liu. Design of the project and data analysis were performed by Xiaojuan Peng, Sisi Yu, Ying Kou, Ping Wu, Zhuzhong Cheng, Yutang Yao, and Jiaqi Shen. The first draft of the manuscript was written by Xiaojuan Peng and the article revision by Sisi Yu, Ying Kou, and Zhuzhong Cheng. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Zhuzhong Cheng.

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This is a retrospective study. The Sichuan Province Research Ethics Committee has confirmed that no ethical approval is required.

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Peng, X., Yu, S., Kou, Y. et al. Prediction nomogram based on 18F-FDG PET/CT and clinical parameters for patients with diffuse large B-cell lymphoma. Ann Hematol 102, 3115–3124 (2023). https://doi.org/10.1007/s00277-023-05336-w

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