Ge Fan, Wu Tingting, Yang Xinyue, Peng Mengye, Yang Chen, Wang Kezheng
PET-CT/MRI Department, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, China.
Department of Radiology, The First People's Hospital of Shuangliu District, West China Airport Hospital of Sichuan University, No. 120 of Chengbei Street, Dongsheng Town, Shuangliu District, Sichuan, Chengdu, 610200, China.
Ann Hematol. 2025 Jun 11. doi: 10.1007/s00277-025-06409-8.
This study aimed to evaluate the predictive value of intra-tumoral F-FDG metabolic heterogeneity in patients with diffuse large B cell lymphoma (DLBCL) in terms of survival.
We retrospectively included 245 patients with DLBCL who underwent F-FDG PET/CT prior to treatment and analyzed using total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) as metabolic volume parameters. The linear regression slopes of TMTV and TLG were calculated according to different percentages of SUV thresholds (i.e., 40%, 50%, 60%, 70%, and 80%), respectively, defined as Heterogeneity Factor-1 (HF1) and Heterogeneity Factor-2 (HF2). These indices of heterogeneity were used to predict progression-free survival (PFS). Based on the results of the Cox proportional hazards model, we constructed a multi-parameter prediction model and evaluated the model in the training and validation cohorts by calibration curve, consistency index (C-index) and decision curve analysis (DCA).
Clinicopathological and PET/CT data from 245 patients were reviewed. 153 patients (62.4%) experienced relapse after treatment. Comparing relapsed and non-relapse patients, all F-FDG PET/CT parameters and heterogeneity index showed significant differences. There were significant differences in survival risk stratification according to HF1 and HF2 cut-off classifications (P < 0.0001). In multivariate Cox regression analysis, SUVmax (P < 0.0001), TLG (P < 0.0001), HF1 (P = 0.004), and HF2 (P < 0.0001) showed significant results. Among the clinicopathological parameters, IPI (P = 0.027) and Size (P < 0.0001) were selected as important parameters.
HF1 and HF2 obtained by the linear regression slope of MTV and TLG may be a novel and useful prognostic marker in DLBCL, which can achieve survival-risk stratification of patients. In addition, multiparametric models have the potential to effectively predict the risk of recurrence in patients.
本研究旨在评估弥漫性大B细胞淋巴瘤（DLBCL）患者瘤内F-FDG代谢异质性对生存的预测价值。
我们回顾性纳入了245例治疗前接受F-FDG PET/CT检查的DLBCL患者，并以总代谢肿瘤体积（TMTV）和总病灶糖酵解（TLG）作为代谢体积参数进行分析。分别根据SUV阈值的不同百分比（即40%、50%、60%、70%和80%）计算TMTV和TLG的线性回归斜率，定义为异质性因子-1（HF1）和异质性因子-2（HF2）。这些异质性指标用于预测无进展生存期（PFS）。基于Cox比例风险模型的结果，我们构建了一个多参数预测模型，并通过校准曲线、一致性指数（C指数）和决策曲线分析（DCA）在训练和验证队列中对该模型进行评估。
回顾了245例患者的临床病理和PET/CT数据。153例患者（62.4%）治疗后复发。比较复发和未复发患者，所有F-FDG PET/CT参数和异质性指数均显示出显著差异。根据HF1和HF2的截断分类，生存风险分层存在显著差异（P < 0.0001）。在多变量Cox回归分析中，SUVmax（P < 0.0001）、TLG（P < 0.0001）、HF1（P = 0.004）和HF2（P < 0.0001）显示出显著结果。在临床病理参数中，国际预后指数（IPI）（P = 0.027）和肿瘤大小（P < 0.0001）被选为重要参数。
通过MTV和TLG的线性回归斜率获得的HF1和HF2可能是DLBCL中一种新颖且有用的预后标志物，可实现患者的生存风险分层。此外，多参数模型有可能有效预测患者的复发风险。
