Triumbari Elizabeth Katherine Anna, Morland David, Cuccaro Annarosa, Maiolo Elena, Hohaus Stefan, Annunziata Salvatore
Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Service de Médecine Nucléaire, Institut Godinot, 51100 Reims, France.
Diagnostics (Basel). 2022 Sep 26;12(10):2325. doi: 10.3390/diagnostics12102325.
(1) This study aimed to investigate whether baseline clinical and Positron Emission Tomography/Computed Tomography (bPET)-derived parameters could help predicting early response to the first two cycles of chemotherapy (Deauville Score at interim PET, DS at iPET) in patients with classical Hodgkin lymphoma (cHL) to identify poor responders (DS ≥ 4) who could benefit from first-line treatment intensification at an earlier time point. (2) cHL patients with a bPET and an iPET imaging study in our Centre’s records (2013−2019), no synchronous/metachronous tumors, no major surgical resection of disease prior to bPET, and treated with two cycles of ABVD chemotherapy before iPET were retrospectively included. Baseline International Prognostic Score for HL (IPS) parameters were collected. Each patient’s bPET total metabolic tumor volume (TMTV) and highest tumoral SUVmax were collected. ROC curves and Youden’s index were used to derive the optimal thresholds of TMTV and SUVmax with regard to the DS (≥4). Chi-square or Fisher’s exact test were used for the univariate analysis. A multivariate analysis was then performed using logistic regression. The type I error rate in the hypothesis testing was set to 5%. (3) A total of 146 patients were included. The optimal threshold to predict a DS ≥ 4 was >177 mL for TMTV and >14.7 for SUVmax (AUC of 0.65 and 0.58, respectively). The univariate analysis showed that only TMTV, SUVmax, advanced disease stage, and age were significantly associated with a DS ≥ 4. A multivariate model was finally derived from TMTV, SUVmax, and age, with an AUC of 0.77. (4) A multivariate model with bPET parameters and age at diagnosis was satisfactorily predictive of poor response at iPET after ABVD induction chemotherapy in cHL patients. More studies are needed to validate these results and further implement DS-predictive factors at baseline in order to prevent poor response and intensify therapeutic strategies a-priori when needed.
(1) 本研究旨在探讨基线临床参数及正电子发射断层扫描/计算机断层扫描（bPET）衍生参数是否有助于预测经典型霍奇金淋巴瘤（cHL）患者前两个化疗周期的早期反应（中期PET的迪氏评分，iPET时的DS），以识别可能从更早的一线治疗强化中获益的无反应者（DS≥4）。(2) 回顾性纳入了本中心记录（2013 - 2019年）中有bPET和iPET影像研究、无同步/异时性肿瘤、bPET前无重大疾病手术切除且在iPET前接受过两个周期ABVD化疗的cHL患者。收集基线国际HL预后评分（IPS）参数。收集每位患者的bPET总代谢肿瘤体积（TMTV）和最高肿瘤SUVmax。使用ROC曲线和尤登指数得出TMTV和SUVmax关于DS（≥4）的最佳阈值。采用卡方检验或费舍尔精确检验进行单因素分析。然后使用逻辑回归进行多因素分析。假设检验中的I型错误率设定为5%。(3) 共纳入146例患者。预测DS≥4的最佳阈值为TMTV＞177 mL，SUVmax＞14.7（AUC分别为0.65和0.58）。单因素分析显示，只有TMTV、SUVmax、疾病晚期和年龄与DS≥4显著相关。最终从TMTV、SUVmax和年龄得出多因素模型，AUC为0.77。(4) 包含bPET参数和诊断时年龄的多因素模型能令人满意地预测cHL患者在ABVD诱导化疗后iPET时的无反应情况。需要更多研究来验证这些结果，并在基线时进一步应用DS预测因素，以便预防无反应并在必要时预先强化治疗策略。
