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Appropriate timing to perform an interim 18F-FDG PET/CT in patients with nasal-type extranodal natural killer/T cell lymphoma

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Abstract

Interim 18F-FDG PET/CT (I-PET) has a role in response evaluation and treatment guidance in patients with nasal-type extranodal natural killer/T cell lymphoma (ENKTL). However, there was no agreement on the timing of I-PET performed, after chemotherapy or after chemoradiotherapy. We aimed to find the appropriate timing for I-PET by assessing the prognostic value of I-PET in response evaluation in ENKTL patients. Two hundred and twenty-seven ENKTL patients who had undergone I-PET were retrospectively included. All patients were grouped based on their therapeutic strategy received, chemotherapy or chemoradiotherapy. The Deauville 5-point score (DS) was used to interpret the I-PET images. The hazard ratio (HR) and C-index were used to measure the discriminatory and prognostic capacities of I-PET performed at different times. One hundred and six patients underwent the I-PET after chemotherapy (chemotherapy group), while I-PET was performed after chemoradiotherapy in 121 patients (chemoradiotherapy group). Eighty-seven patients were classified as metabolic remission (DS score of 1–3), while the other 140 were classified as non-metabolic remission (DS score of 4–5) according to the Deauville criteria. There were no significant survival differences between patients in metabolic remission and in non-metabolic remission in either progression-free survival (PFS, p = 0.406) or overall survival (OS, p = 0.350). In the chemotherapy group, patients in metabolic remission had significantly superior PFS than patients in non-metabolic remission (p = 0.012). For OS, a discriminative trend was also found on the survival curve between patients in metabolic remission and in non-metabolic remission (p = 0.082). In the chemoradiotherapy group, there was no significant difference in PFS (P = 0.185) or OS (P = 0.627) between patients in metabolic remission and in non-metabolic remission. I-PET after chemotherapy yields higher discriminative power and has the ability for prognostic prediction in nasal-type ENKTL patients. I-PET after radiochemotherapy has no prognostic value. Thus, the appropriate timing for I-PET is after chemotherapy but before radiotherapy for response evaluation in nasal-type ENKTL patients.

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Funding

This work was supported by the Post-Doctor Research Project, West China Hospital, Sichuan University (grant 2023HXBH075).

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Author notes

  1. Rang Wang and Yue Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China

    Rang Wang, Yue Zhang, Qiuping Fan & Minggang Su

  2. Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China

    Ming Jiang & Liqun Zou

Authors
  1. Rang Wang
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Contributions

Conceived and designed the experiments: RW and MGS. Performed the experiments: RW, YZ, and QPF. Analyzed the data: RW, YZ, and MGS. Contributed reagents/materials/analysis tools: RW, YZ, and MGS. Provided critical input into the design and drafting of the manuscript: MJ and LQZ. Wrote and revised the paper: RW and MGS.

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Correspondence to Minggang Su.

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Sichuan University West China Hospital Review Board approved the study.

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All patients signed informed consent before undergoing PET/CT scans.

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The authors declare no competing interests.

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Wang, R., Zhang, Y., Fan, Q. et al. Appropriate timing to perform an interim 18F-FDG PET/CT in patients with nasal-type extranodal natural killer/T cell lymphoma. Ann Hematol 103, 885–892 (2024). https://doi.org/10.1007/s00277-023-05562-2

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