FDG PET/CT Maximum Tumor Dissemination to Predict Recurrence in Patients with Diffuse Large B-Cell Lymphoma

Joon-Hyung Jo; Hyun Woo Chung; Sung-Yong Kim; Mark Hong Lee; Young So

doi:10.1007/s13139-022-00782-2

FDG PET/CT Maximum Tumor Dissemination to Predict Recurrence in Patients with Diffuse Large B-Cell Lymphoma

Nucl Med Mol Imaging. 2023 Feb;57(1):26-33. doi: 10.1007/s13139-022-00782-2. Epub 2022 Oct 27.

Authors

Joon-Hyung Jo¹, Hyun Woo Chung^{1

2}, Sung-Yong Kim^{2

3}, Mark Hong Lee^{2

3}, Young So^{1

2}

Affiliations

¹ Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030 South Korea.
² Research Institute of Biomedical Science, Konkuk University School of Medicine, Seoul, 05030 South Korea.
³ Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea.

Abstract

Purpose: We investigated the prognostic value of maximum tumor dissemination (Dmax), the distance between malignant lesions that were farthest apart, as assessed by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), and other clinical factors in patients with diffuse large B-cell lymphoma (DLBCL).We investigated the prognostic value of maximum tumor dissemination (Dmax), the distance between malignant lesions that were farthest apart, as assessed by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), and other clinical factors in patients with diffuse large B-cell lymphoma (DLBCL).

Methods: Patients who underwent FDG PET/CT for initial staging and treatment response evaluation of DLBCL were reviewed retrospectively. Baseline Dmax, maximum standardized uptake value, total summation of all metabolic tumor volumes (tMTV), and total summation of all total lesion glycolysis (tTLG) were measured. The treatment response was evaluated at the interim and end of first-line treatment (EOT) using the Deauville score (DS). FDG PET/CT parameters and other clinical factors including sex, age, serum lactate dehydrogenase (LDH) level, stage, performance status, and the International Prognostic Index (IPI) were analyzed to identify factors prognostic of the time to progression (TTP) and disease-specific survival (DSS).

Results: A total of 63 patients were included. Univariate survival analysis identified Dmax (> 275 mm), tMTV (> 180 mL), tTLG (> 1300), interim DS (≥ 4), and EOT DS (≥ 4) as significant predictors of poor TTP. Serum LDH level (> 640 IU/L), IPI (≥ 4), tMTV (> 180 mL), tTLG (> 1300), interim DS (≥ 4), and EOT DS (≥ 4) were significant predictors of DSS. After multivariate survival analysis, Dmax (P = 0.008) and EOT DS (P = 0.005) were independent predictors of TTP. EOT DS was an independent predictor of DSS (P = 0.029).

Conclusions: Dmax at the time of diagnosis and the EOT response assessed by FDG PET/CT provide useful prognostic information additive to the IPI in patients with DLBCL.

Keywords: Deauville score; Diffuse large B-cell lymphoma; FDG PET/CT; Maximum tumor dissemination; Prognosis.

© The Author(s), under exclusive licence to Korean Society of Nuclear Medicine 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.