National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Department of Radiation Oncology, Tianjin Medical University, Tianjin, China.
Cancer Med. 2023 Aug;12(16):16734-16743. doi: 10.1002/cam4.6295. Epub 2023 Jun 27.
This study aimed to integrate positron emission tomography/computed tomography (PET/CT) metrics and genetic mutations to optimize the risk stratification for diffuse large B-cell lymphoma (DLBCL) patients.
The data of 94 primary DLBCL patients with baseline PET/CT examination completed in the Shandong Cancer Hospital and Institute (Jinan, China) were analyzed to establish a training cohort. An independent cohort of 45 DLBCL patients with baseline PET/CT examination from other hospitals was established for external validation. The baseline total metabolic tumor volume (TMTV) and the largest distance between two lesions (Dmax) standardized by patient body surface area (SDmax) were calculated. The pretreatment pathological tissues of all patients were sequenced by a lymphopanel including 43 genes.
The optimal TMTV cutoff was 285.3 cm and the optimal SDmax cutoff was 0.135 m . TP53 status was found as an independent predictive factor significantly affecting complete remission (p = 0.001). TMTV, SDmax, and TP53 status were the main factors of the nomogram and could stratify the patients into four distinct subgroups based on their predicted progression-free survival (PFS). The calibration curve demonstrated satisfactory agreement between the predicted and actual 1-year PFS of the patients. The receiver operating characteristic curves showed this nomogram based on PET/CT metrics and TP53 mutations had a better predictive ability than the clinic risk scores. Similar results were identified upon external validation.
The nomogram based on imaging factors and TP53 mutations could lead to a more accurate selection of DLBCL patients with rapid progression, to increase tailor therapy.
本研究旨在整合正电子发射断层扫描/计算机断层扫描（PET/CT）指标和基因突变，以优化弥漫性大 B 细胞淋巴瘤（DLBCL）患者的风险分层。
分析了 94 例在山东省肿瘤医院（济南）完成基线 PET/CT 检查的原发性 DLBCL 患者的数据，以建立训练队列。来自其他医院的 45 例基线 PET/CT 检查的 DLBCL 患者组成独立队列进行外部验证。计算了基线总代谢肿瘤体积（TMTV）和经患者体表面积标准化的最大病变间距离（SDmax）。对所有患者的预处理病理组织进行了包括 43 个基因的淋巴panel 测序。
最佳 TMTV 截断值为 285.3 cm，最佳 SDmax 截断值为 0.135 m。TP53 状态被发现是一个独立的预测因素，显著影响完全缓解（p=0.001）。TMTV、SDmax 和 TP53 状态是列线图的主要因素，可以根据预测的无进展生存（PFS）将患者分为四个不同的亚组。校准曲线显示，患者的预测 1 年 PFS 与实际 PFS 之间具有较好的一致性。受试者工作特征曲线表明，基于 PET/CT 指标和 TP53 突变的列线图比临床风险评分具有更好的预测能力。外部验证也得到了类似的结果。
基于影像学因素和 TP53 突变的列线图可以更准确地选择进展迅速的 DLBCL 患者，以增加个体化治疗。
