Xin Wenchong, Wang Fei, Gu Weiying, Wang Yuetao
Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, China.
Quant Imaging Med Surg. 2025 Sep 1;15(9):8096-8111. doi: 10.21037/qims-2024-2699. Epub 2025 Aug 19.
Intratumoral metabolic heterogeneity (MH) assessed by 18-fluorine fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) has been recognized as a potential marker for chemotherapy resistance in solid tumors. However, research on MH in diffuse large B-cell lymphoma (DLBCL) is limited, and its specific relationship with the response to immunochemotherapy (IC) remains unclear. The objective of this study was to investigate optimal approaches for assessing intratumoral MH, and to analyze the association between PET/CT-based MH and end of treatment (EOT) response to IC in DLBCL.
This study retrospectively enrolled 304 newly diagnosed patients with DLBCL who underwent baseline F-FDG PET/CT scanning. Intratumoral MH was assessed by the method of the area under the curve of cumulative standardized uptake value (SUV) histogram (AUC-CSH), heterogeneity index (HI), and coefficient of variation (COV) of target lesion. Both univariate and multivariate logistic regression analyses were employed to investigate the association between intratumoral MH and the response to IC at the EOT. After adjusting for confounding factors, we utilized generalized additive model (GAM) and smooth curve fitting to explore potential nonlinear associations, and a binary logistic regression model was used to assess interactions within subgroups.
A total of 70 patients (23%) developed primary progressive disease (PPD) at the EOT. Both AUC-CSH and HI were associated with the IC response in DLBCL, with AUC-CSH slightly superior to HI. No significant statistical difference was observed for COV. Univariate regression analysis revealed a significant association between AUC-CSH and the response to IC [odds ratio (OR)/per standard deviation (SD): 0.53; 95% confidence interval (CI): 0.38-0.73; P<0.001]. After adjusting for risk factors, this association remained significant (OR/per SD: 0.58; 95% CI: 0.40-0.85; P=0.006). The GAM indicated a negative linear association between AUC-CSH and the probability of developing PPD, with the top tertile group having the lowest likelihood of developing PPD (14.8%).
In Chinese patients with DLBCL, an approximately negative linear correlation was observed between the AUC-CSH and the probability of developing PPD at the EOT of frontline IC. In simpler terms, as the degree of intratumoral MH increases, the probability of developing PPD also increases.
通过18-氟氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）评估的肿瘤内代谢异质性（MH）已被认为是实体瘤化疗耐药的潜在标志物。然而，关于弥漫性大B细胞淋巴瘤（DLBCL）中MH的研究有限，其与免疫化疗（IC）反应的具体关系仍不清楚。本研究的目的是探讨评估肿瘤内MH的最佳方法，并分析基于PET/CT的MH与DLBCL中IC治疗结束（EOT）反应之间的关联。
本研究回顾性纳入了304例新诊断的DLBCL患者，这些患者均接受了基线F-FDG PET/CT扫描。通过累积标准化摄取值（SUV）直方图曲线下面积（AUC-CSH）、异质性指数（HI）和靶病灶变异系数（COV）方法评估肿瘤内MH。采用单因素和多因素逻辑回归分析来研究肿瘤内MH与EOT时IC反应之间的关联。在调整混杂因素后，我们利用广义相加模型（GAM）和平滑曲线拟合来探索潜在的非线性关联，并使用二元逻辑回归模型评估亚组内的相互作用。
共有70例患者（23%）在EOT时出现原发性进行性疾病（PPD）。AUC-CSH和HI均与DLBCL中的IC反应相关，AUC-CSH略优于HI。COV未观察到显著统计学差异。单因素回归分析显示AUC-CSH与IC反应之间存在显著关联[比值比（OR）/每标准差（SD）：0.53；95%置信区间（CI）：0.
