Lopci Egesta, Elia Caterina, De Re Valli, Mussolin Lara, Piccardo Arnoldo, Cistaro Angelina, Bianchi Maurizio, Bianchi Simona, Buffardi Salvatore, Garaventa Alberto, Zucchetta Pietro, Kurch Lars, Castello Angelo, Muggeo Paol, Sala Alessandra, Vinti Luciana, Mascarin Maurizio
Nuclear Medicine, IRCCS - Humanitas Research Hospital, Rozzano, MI, Italy.
Radiation Oncology, AYA and Pediatric Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
Eur J Nucl Med Mol Imaging. 2025 Sep 16. doi: 10.1007/s00259-025-07537-z.
The aim of the present trial is to investigate the predictive and prognostic role of PET volumetric parameters and maximal dissemination (Dmax) in pediatric Hodgkin lymphoma (HL).
This is a prospective, multicenter study conducted in 35 AIEOP centers. Between March 2018 and December 2020, pediatric HL patients undergoing the same therapeutic trial have been enrolled. Patients underwent PET at baseline (PET0), for early (ERA), and late response assessment (LRA). The parameters analyzed were SUVmax, SUVmean, Dmax, TMTV (total metabolic tumor volume), TLG (total lesion glycolysis), and their (Δ) variations at different timing. Clinical and imaging parameters have been correlated to response, classified into adequate (AR) and inadequate (IR), based on protocol definition, and the event-free survival (EFS).
Overall, 300 patients were enrolled: 144 were male (48%), 167 stage I-II and 133 stage III-IV, 114 presented with bulky masses (> 200 ml), whereas 167 patients showed B-symptoms. All PET0 parameters resulted significantly correlated to ERA PET. With respect to the outcome, volumetric parameters and Dmax resulted prognostic at PET0, while semi-quantitative parameters and Dmax resulted prognostic at ERA PET. At multivariate analyses, an independent prognostic role was proven for stage (p = 0.0026), bulky volume (p < 0.0001), and Dmax (p = 0.0388) at PET0. Whereas, Dmax (p = 0.0025) and ΔSUVmax (p = 0.0297) resulted independent prognostic factors at ERA. By combining factors, we found a significant difference for patients with no risk factors at PET0 compared to patients with three risk factors (HR 17.701; p < 0.0001). At ERA PET, the poorest outcome was reached in case of bi-factorial risks, with a mean EFS of 56.4 months (HR 23.489; p < 0.0001).
To our knowledge, this is the first large, prospective, multicenter study of its type in pediatric patients. Our findings demonstrate the role of PET volumetric parameters in pediatric HL. Moreover, as first evidence in children, Dmax showed a proper predictive and prognostic role in HL. By combining these factors, we could stratify patients into risk-groups based on the outcomes.
本试验旨在研究PET体积参数和最大播散范围（Dmax）在儿童霍奇金淋巴瘤（HL）中的预测和预后作用。
这是一项在35个AIEOP中心进行的前瞻性多中心研究。2018年3月至2020年12月期间，纳入了接受相同治疗试验的儿童HL患者。患者在基线（PET0）、早期反应评估（ERA）和晚期反应评估（LRA）时接受PET检查。分析的参数包括SUVmax、SUVmean、Dmax、总代谢肿瘤体积（TMTV）、总病变糖酵解（TLG）以及它们在不同时间的（Δ）变化。临床和影像参数与根据方案定义分为充分反应（AR）和不充分反应（IR）的反应以及无事件生存期（EFS）相关。
总体而言，共纳入300例患者：144例为男性（48%），167例为I-II期，133例为III-IV期，114例有巨大肿块（>200 ml），167例有B症状。所有PET0参数均与ERA PET显著相关。关于预后，PET0时体积参数和Dmax具有预后意义，而ERA PET时半定量参数和Dmax具有预后意义。在多变量分析中，PET0时分期（p = 0.0026）、巨大肿块体积（p < 0.0001）和Dmax（p = 0.0388）被证明具有独立的预后作用。而在ERA时，Dmax（p = 0.0025）和ΔSUVmax（p = 0.0297）是独立的预后因素。通过综合这些因素，我们发现PET0时无危险因素的患者与有三个危险因素的患者之间存在显著差异（HR 17.701；p < 0.0001）。在ERA PET时，双因素风险情况下预后最差，平均EFS为56.4个月（HR 23.489；p < 0.0001）。
据我们所知，这是此类针对儿童患者的首个大型前瞻性多中心研究。我们的研究结果证明了PET体积参数在儿童HL中的作用。此外，作为儿童中的首个证据，Dmax在HL中显示出适当的预测和预后作用。通过综合这些因素，我们可以根据预后将患者分层为风险组。
