Value of 18 F-FDG PET/CT for prognostic stratification in patients with primary intestinal diffuse large B cell lymphoma
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ORIGINAL ARTICLE
Value of 18F‑FDG PET/CT for prognostic stratification in patients with primary intestinal diffuse large B cell lymphoma treated with an R‑CHOP‑like regimen Chong Jiang1 · Yue Teng1 · Jieyu Chen2 · Zhen Wang3 · Zhengyang Zhou1 · Chongyang Ding4 · Jingyan Xu5 Received: 13 July 2020 / Accepted: 7 September 2020 © The Japanese Society of Nuclear Medicine 2020
Abstract Purpose The prognostic value of 18F-FDG PET/CT for primary intestinal diffuse large B-cell lymphoma (PI-DLBCL) patients has not been determined. This prompted us to explore the value of 18F-FDG PET/CT for prognostic stratification in patients with PI-DLBCL treated with an R-CHOP-like regimen. Materials and methods Seventy-three PI-DLBCL patients who underwent baseline PET/CT between January 2010 and May 2019 were included in this retrospective study. Total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) were computed using the 41% SUVmax thresholding method. Progression-free survival (PFS) and overall survival (OS) were used as endpoints to evaluate prognosis. Results During the follow-up period of 3–117 months (29.0 ± 25.5 months), high TLG, non-germinal center B-cell-like (non-GCB) and high National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) were significantly associated with inferior PFS and OS. TLG, cell-of-origin and NCCN-IPI were independent predictors of PFS, and both TLG and NCCN-IPI were independent predictors of OS. The grading system was based on the number of risk factors (high TLG, non-GCB, high NCCN-IPI) and patients were divided into 4 risk groups (PFS: χ2 = 33.858, P 1 to ≤ 3 times normal > 3 times normal Primary tumor site, small intestine/large intestine B symptoms, no/yes ECOG performance status, 0–1/ > 1 No. of extranodal sites, 1/ ≥ 2 Modified Ann Arbor stagea, I–II/III–IV IPI, 0–2/3–5 NCCN-IPI, 0–3/4–8 Bulky disease, no/yes Cell-of-origin, GCB/non-GCB SUVmax of the liverb SUVmaxb TMTV (cm3)b TLGb
27/46 62 (20–82) 9 26 31 7 46/27 46 19 8 39/34 43/30 61/12 55/18 24/49 51/22 46/27 44/29 32/41 2.7 (2.2–3.3) 22.8 (7.3–45.6) 124.2 (2.8–4323.6) 1430.0 (22.9–19,958.4)
F female, M male, LDH lactate dehydrogenase, ECOG PS Eastern Cooperative Oncology Group performance status, IPI International Prognostic Index, NCCN-IPI National Comprehensive Cancer Network International Prognostic Index, GCB germinal center B-cell, SUVmax maximum standardized uptake value, TMTV total metabolic tumor volume, TLG total lesion glycolysis a
The Musshoff modified Ann Arbor stage
b
Median (range)
13
Annals of Nuclear Medicine
Table 2 MTV and TLG in relation to patient clinical parameters Characteristics
Sex, F/M Age, ≤ 60/ > 60 Primary tumor site, small intestine/large intestine LDH level, normal/elevated B symptoms, no/yes ECOG PS, 0–1/ ≥ 2 No. of extranodal sites, 1/ ≥ 2 Modified Ann Abor stage†, I–II/III–IV IPI, 0–2/3–5 NCCN-IPI, 0–3/4–8 Bulky disease, no/yes Cell-of-origin, GCB/non-GCB
No. of patients (n = 73)
TMTV
27/46 35/38 39/34 46/27 43/30 61/12 55/18 24/49 51/22 46/
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