Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, China.
BMC Cancer. 2024 Jul 25;24(1):895. doi: 10.1186/s12885-024-12668-x.
The metabolic tumour area (MTA) was found to be a promising predictor of prostate cancer. However, the role of MTA based on F-FDG PET/CT in diffuse large B-cell lymphoma (DLBCL) prognosis remains unclear. This study aimed to elucidate the prognostic significance of MTA and evaluate its incremental value to the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) for DLBCL patients treated with first-line R-CHOP regimens.
A total of 280 consecutive patients with newly diagnosed DLBCL and baseline F-FDG PET/CT data were retrospectively evaluated. Lesions were delineated via a semiautomated segmentation method based on a 41% SUVmax threshold to estimate semiquantitative metabolic parameters such as total metabolic tumour volume (TMTV) and MTA. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values. Progression-free survival (PFS) and overall survival (OS) were the endpoints that were used to evaluate the prognosis. PFS and OS were estimated via Kaplan‒Meier curves and compared via the log-rank test.
Univariate analysis revealed that patients with high MTA, high TMTV and NCCN-IPI ≥ 4 were associated with inferior PFS and OS (P < 0.0001 for all). Multivariate analysis indicated that MTA remained an independent predictor of PFS and OS [hazard ratio (HR), 2.506; 95% confidence interval (CI), 1.337-4.696; P = 0.004; and HR, 1.823; 95% CI, 1.005-3.310; P = 0.048], whereas TMTV was not. Further analysis using the NCCN-IPI model as a covariate revealed that MTA and NCCN-IPI were still independent predictors of PFS (HR, 2.617; 95% CI, 1.494-4.586; P = 0.001; and HR, 2.633; 95% CI, 1.650-4.203; P < 0.0001) and OS (HR, 2.021; 95% CI, 1.201-3.401; P = 0.008; and HR, 3.869; 95% CI, 1.959-7.640; P < 0.0001; respectively). Furthermore, MTA was used to separate patients with high NCCN-IPI risk scores into two groups with significantly different outcomes.
Pre-treatment MTA based on F-FDG PET/CT and NCCN-IPI were independent predictor of PFS and OS in DLBCL patients treated with R-CHOP. MTA has additional predictive value for the prognosis of patients with DLBCL, especially in high-risk patients with NCCN-IPI ≥ 4. In addition, the combination of MTA and NCCN-IPI may be helpful in further improving risk stratification and guiding individualised treatment options.
This research was retrospectively registered with the Ethics Committee of the Third Affiliated Hospital of Soochow University, and the registration number was approval No. 155 (approved date: 31 May 2022).
代谢肿瘤区（MTA）已被证明是前列腺癌有前途的预测指标。然而，基于 F-FDG PET/CT 的 MTA 在弥漫性大 B 细胞淋巴瘤（DLBCL）预后中的作用仍不清楚。本研究旨在阐明 MTA 的预后意义，并评估其对接受一线 R-CHOP 方案治疗的 DLBCL 患者的国家综合癌症网络国际预后指数（NCCN-IPI）的增量价值。
回顾性评估了 280 例新诊断为 DLBCL 且基线有 F-FDG PET/CT 数据的连续患者。通过基于 41% SUVmax 阈值的半自动分割方法对病变进行描绘，以估计半定量代谢参数，如总代谢肿瘤体积（TMTV）和 MTA。使用接收者操作特征（ROC）曲线分析来确定最佳截断值。无进展生存期（PFS）和总生存期（OS）是评估预后的终点。通过 Kaplan-Meier 曲线估计 PFS 和 OS，并通过对数秩检验进行比较。
单因素分析显示，MTA 较高、TMTV 较高和 NCCN-IPI≥4 的患者 PFS 和 OS 较差（所有 P<0.0001）。多因素分析表明，MTA 仍然是 PFS 和 OS 的独立预测因素[风险比（HR），2.506；95%置信区间（CI），1.337-4.696；P=0.004；和 HR，1.823；95% CI，1.005-3.310；P=0.048]，而 TMTV 不是。使用 NCCN-IPI 模型作为协变量的进一步分析表明，MTA 和 NCCN-IPI 仍然是 PFS 的独立预测因素（HR，2.617；95% CI，1.494-4.586；P=0.001；和 HR，2.633；95% CI，1.650-4.203；P<0.0001）和 OS（HR，2.021；95% CI，1.201-3.401；P=0.008；和 HR，3.869；95% CI，1.959-7.640；P<0.0001）。此外，MTA 可用于将 NCCN-IPI 风险评分较高的患者分为两组，两组的预后有显著差异。
基于 F-FDG PET/CT 的 MTA 和 NCCN-IPI 是 R-CHOP 治疗的 DLBCL 患者 PFS 和 OS 的独立预测因素。MTA 对 DLBCL 患者的预后具有额外的预测价值，特别是在 NCCN-IPI≥4 的高危患者中。此外，MTA 和 NCCN-IPI 的组合可能有助于进一步改善风险分层，并指导个体化治疗选择。
本研究是在苏州大学附属第三医院伦理委员会进行的回顾性注册，注册号为 155（批准日期：2022 年 5 月 31 日）。
