Durmo Rexhep, Chauvie Stephane, Minoia Carla, Bergesio Fabrizio, Fallanca Federico, Peano Simona, Marcheselli Luigi, Anastasia Antonella, Boccomini Carola, Corradini Paolo, Olivieri Jacopo, Arcaini Luca, Cavallo Federica, Ibatici Adalberto, Nassi Luca, Tarantino Vittoria, Pinto Antonello, Stelitano Caterina, Pulsoni Alessandro, Ricci Francesca, Mancuso Salvatrice, Cencini Emanuele, Di Renzo Nicola, Mannarella Clara, Palmas Angelo, Zinzani Pierluigi, Bocci Caterina, Rossi Francesca, Carella Angelo Michele, Federico Massimo, Versari Annibale, Guerra Luca, Luminari Stefano
Nuclear Medicine, Azienda USL IRCCS of Reggio Emilia, Reggio Emilia, Italy.
Santa Croce e Carle Hospital, Medical Physics, Cuneo, Italy.
Am J Hematol. 2025 Jul;100(7):1196-1204. doi: 10.1002/ajh.27711. Epub 2025 May 14.
Discordant results have been generated regarding the prognostic role of Total Metabolic Tumor Volume (TMTV) in Follicular Lymphoma (FL). The use of prospective data and the adoption of the newly defined standardized SUV4 method for calculating TMTV may generate stronger evidence. We conducted a pre-planned post hoc analysis of the prospective multicenter randomized phase III FOLL12 trial for newly diagnosed high tumor burden FL (grade 1-3a), which mandated baseline staging with PET. Baseline PET/CT scans were reviewed centrally, and TMTV was calculated using the fixed threshold of SUV4. Kaplan-Meier and Cox regression were used for survival analysis. The primary study endpoint was Progression free Survival (PFS). A total of 689 FL patients were available for TMTV definition. Median TMTV was 161 mL (IQR 50 to 388 mL) and the best cutoff value was set at 180 mL. Patients with high TMTV had a significantly lower 5-year PFS compared to those with low TMTV: 59% (95% CI, 53-65%) vs. 74% (95% CI, 69-78%) HR 1.61 (95% CI, 1.24-2.09). Prognostic role of TMTV was independent of study arm, chemotherapy regimen, and FLIPI2. Combined with FLIPI-2, we identified three groups with different 5-yr PFS rates, with the lowest rates (51%) for patients with high TMTV and high FLIPI2. Combined TMTV and FLIPI model was also prognostic to predict the risk of early progression and of death. Applying the SUV4 standard method pre-treatment TMTV is confirmed as a strong and independent predictor of PFS in FL patients. Integrating TMTV with FLIPI-2 improves risk assessment.
关于总代谢肿瘤体积（TMTV）在滤泡性淋巴瘤（FL）中的预后作用，已得出不一致的结果。使用前瞻性数据以及采用新定义的标准化SUV4方法来计算TMTV可能会产生更有力的证据。我们对新诊断的高肿瘤负荷FL（1-3a级）的前瞻性多中心随机III期FOLL12试验进行了预先计划的事后分析，该试验要求进行PET基线分期。对基线PET/CT扫描进行集中审查，并使用SUV4的固定阈值计算TMTV。采用Kaplan-Meier法和Cox回归进行生存分析。主要研究终点是无进展生存期（PFS）。共有689例FL患者可用于TMTV定义。TMTV中位数为161毫升（IQR 50至388毫升），最佳临界值设定为180毫升。高TMTV患者的5年PFS显著低于低TMTV患者：59%（95%CI，53-65%）对74%（95%CI，69-78%），HR 1.61（95%CI，1.24-2.09）。TMTV的预后作用独立于研究组、化疗方案和FLIPI2。结合FLIPI-2，我们确定了三组5年PFS率不同的患者，高TMTV和高FLIPI2的患者5年PFS率最低（51%）。联合TMTV和FLIPI模型也可用于预测早期进展和死亡风险。应用SUV4标准方法进行治疗前TMTV测定，证实其为FL患者PFS的强有力且独立的预测指标。将TMTV与FLIPI-2相结合可改善风险评估。
