Vergote Vibeke K J, Verhoef Gregor, Janssens Ann, Woei-A-Jin F J S, Deckers Wies, Laenen Annouschka, Tousseyn Thomas, Dierickx Daan, Deroose Christophe M
Hematology, UZ Leuven, Leuven, Belgium.
Department of Hematology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Eur J Nucl Med Mol Imaging. 2025 Jun 16. doi: 10.1007/s00259-025-07368-y.
Large B-cell lymphomas (LBCL) include diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), and subtypes such as transformed non-Hodgkin's lymphoma (tNHL), primary mediastinal B-cell lymphoma (PMBL), and double/triple-hit lymphomas (DHL/THL). While metabolic risk scores based on metabolic tumor volume (MTV) have demonstrated prognostic value in DLBCL, NOS, their applicability to other LBCL subtypes remains unclear.
Baseline [F]FDG-PET/CT scans of LBCL patients treated with R-CHOP regimens at our institution were retrospectively analyzed. Metabolic parameters, including MTV, lesion dissemination (SDmax) and tumor surface volume ratio were calculated for each histological subgroup. Four metabolic risk scores-the international metabolic prognostic index (IMPI), MTV/WHO PS, MTV/SDmax and Clinical PET model- were applied to calculate progression risk in LBCL subtypes. Harrell's C-index evaluated the prognostic performance. A multivariable model was developed for tNHL.
We included tNHL (n = 88), DHL/THL (n = 32), PMBL (n = 26) and others (n = 49), and compared them to a cohort of previously published DLBCL, NOS (n = 355). IMPI demonstrated the highest C-index amongst the metabolic risk scores in tNHL for progression-free survival (PFS), overall survival, time to progression and progression of disease within 12 months, but was outperformed by the IPI. For DHL/THL the highest C-indices were observed for MTV/WHO PS. For PMBL the clinical PET score showed the highest C-indices. SDmax improved prognostic predictions in PMBL and tNHL, but not in DHL/THL. Multivariate analysis identified independent predictors of PFS in tNHL, including IPI and SUV.
Metabolic risk scores show variable prognostic value across LBCL subtypes. Subtype-specific metabolic models may enhance personalized risk stratification and guide treatment approaches.
大B细胞淋巴瘤（LBCL）包括弥漫性大B细胞淋巴瘤，未另行分类（DLBCL，NOS），以及转化型非霍奇金淋巴瘤（tNHL）、原发性纵隔B细胞淋巴瘤（PMBL）和双/三打击淋巴瘤（DHL/THL）等亚型。虽然基于代谢肿瘤体积（MTV）的代谢风险评分已在DLBCL，NOS中显示出预后价值，但其在其他LBCL亚型中的适用性仍不清楚。
对在我们机构接受R-CHOP方案治疗的LBCL患者的基线[F]FDG-PET/CT扫描进行回顾性分析。计算每个组织学亚组的代谢参数，包括MTV、病灶播散（SDmax）和肿瘤表面积体积比。应用四个代谢风险评分——国际代谢预后指数（IMPI）、MTV/WHO PS、MTV/SDmax和临床PET模型——来计算LBCL亚型的进展风险。Harrell's C指数评估预后性能。为tNHL建立了多变量模型。
我们纳入了tNHL（n = 88）、DHL/THL（n = 32）、PMBL（n = 26）和其他类型（n = 49），并将它们与一组先前发表的DLBCL，NOS（n = 355）进行比较。在tNHL中，IMPI在无进展生存期（PFS）、总生存期、进展时间和12个月内疾病进展的代谢风险评分中显示出最高的C指数，但在无进展生存期方面不如国际预后指数（IPI）。对于DHL/THL，MTV/WHO PS显示出最高的C指数。对于PMBL，临床PET评分显示出最高的C指数。SDmax改善了PMBL和tNHL的预后预测，但在DHL/THL中没有。多变量分析确定了tNHL中PFS的独立预测因素，包括IPI和SUV。
代谢风险评分在不同LBCL亚型中显示出不同的预后价值。亚型特异性代谢模型可能会增强个性化风险分层并指导治疗方法。
