Application of an interim18F- FDG PET/CT interpretation method for evaluating the prognosis of diffuse large B-cell lymphoma / 中国肿瘤临床

ABSTRACT

Objective: To investigate the role of the Deauville five-point scale (5-PS) and maximum standard uptake value variation (△ SUVmax) measures of interim positron emission tomography/computed tomography (PET-CT) in the prognosis evaluation of patients with diffuse large B-cell lymphoma (DLBCL). Methods: A total of 94 patients with histologically confirmed DLBCL at The First Affiliated Hospital of Chongqing Medical University from October 2012 to June 2018 were enrolled in this retrospective study. Clinical characteristics and prognostic factors of patients were analyzed. Survival data were analyzed using the Kaplan-Meier method and Cox proportional hazards model. The prognostic value of △SUVmax and 5-PS in patients with DLBCL was evaluated using the Chi-square test. Results: 5-PS and △SUVmax were grouped by scores of 4 and 86%, respectively. Progression free survival (PFS) and overall survival (OS) were longer in the 5-PS score <4 group than in the 5-PS score ≥4 group. Patients in the △SUVmax ≥86% group had better PFS and OS than those in the △SUVmax <86% group (P<0.05). △SUVmax and 5-PS measures had high negative predictive values (89.4% and 93.6%, respectively; 76.1% and 85.9%, respectively) and low positive predictive values (48.9% and 31.9%, respectively; 47.8% and 34.8%, respectively) for PFS and OS. △SUVmax was more sensitive than 5-PS for the corresponding parameters (82.1% vs. 39.3% and 83.3% vs. 44.4%, respectively). Univariate analysis showed that international prognostic index (IPI) (P=0.007), △SUVmax (P<0.001), 5-PS (P=0.014) and baseline total metabolic tumor volume (TMTV) (P=0.001) were associated with PFS. △SUVmax (P=0.014), 5-PS (P= 0.033), and TMTV (P=0.004) were related to OS. Multivariate analysis showed that TMTV was an independent predictor of OS (P= 0.005). △SUVmax and TMTV were independent predictors of PFS (P=0.002, P=0.020). The PFS of patients with △SUVmax < 86% and high TMTV was significantly shorter than that of those with △SUVmax <86% with low TMTV (P=0.001). Conclusions: 5-PS and △SUVmax can be used to evaluate the prognosis of DLBCL patients. However, the predictive value of △SUVmax was higher than that of 5-PS, and combining △SUVmax with baseline TMTV could further stratify the risk of DLBCL patients.