Evaluating early interim fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography with the SUV_max-liver-based interpretation for predicting the outcome in diffuse large B-cell lymphoma

Abstract

Interim F-FDG PET/CT is an effective predictor in patients with DLBCL, but the standard evaluating criteria were controversial. In this study, investigators tried to investigate whether the liver SUV (SUV)-based interpretation could improve the accuracy of predicting the outcomes, comparing with the Deauville five-point scale (5-PS) and the reduction rate of the maximum standardized uptake value (ΔSUV) criteria. In 119 patients, PET/CT after two chemotherapy cycles (PET2) were evaluated with the SUV-based interpretation, 5-PS, and ΔSUV criteria. Uni- and multivariate analyses were performed. The optimal threshold for the SUV-based interpretation was 1.6 fold of SUV. Using the SUV-based interpretation, the 3-year PFS and OS were 19.9% and 33.0% for patients with a positive residue while 78.2% and 86.4% for patients with negative results (p < .001). SUV-based interpretation demonstrated slightly superior accuracy, and was independent predictor for PFS and OS (p ≤ .001). Thus, early interim F-FDG PET/CT effectively predicts the outcome in patients with DLBCL using SUV-based interpretation.

Interim PET/CT Result Is The Sole Prognostic Factor Of Survival In Patients With Advanced-Stage Diffuse Large B-cell Lymphoma：A Prospective Trial

“…Recently, several studies have shown that PET/CT was a more valid prognosticator of survival for patients with DLBCL than traditional clinicopathologic factors such as IPI score [21][22][23][24][25]. Our results confirm that only iPET was a significant independent indicator of outcome for patients with DLBCL in the rituximab era.…”

Interim PET/CT Result Is The Sole Prognostic Factor Of Survival In Patients With Advanced-Stage Diffuse Large B-cell Lymphoma：A Prospective Trial

“…Recently, several studies have shown that PET/CT was a more valid prognosticator of survival for patients with DLBCL than traditional clinicopathologic factors such as IPI score [21][22][23][24][25]. Our results confirm that only iPET was a significant independent indicator of outcome for patients with DLBCL in the rituximab era.…”

Predictive value of interim positron emission tomography in diffuse large B-cell lymphoma: a systematic review and meta-analysis

“…Negative predictive values for 2-year progression-free status were generally above 80%, except in four studies [ 34 , 35 , 39 , 53 ]. In Mamot et al [ 39 ], the somewhat lower negative predictive value could possibly be explained because radiotherapy (administered regardless of PET results) was counted as an event and resulted in a lower EFS rate compared to other clinical trials.…”

“…We found widely ranging positivity rates between studies, which are mainly in agreement with the timing of interim PET between cycles and the criteria used. In an exploratory analysis on five studies [ 34 , 37 – 39 , 47 ] that performed interim PET strictly after 2 cycles of therapy and applied the Deauville scoring system we found a pooled estimated HR of 3.48 (95% CI 2.46–4.93) with a corresponding 95% prediction interval of 1.58–7.67 (Supplemental Fig. 3 ).…”

“…Most articles adjusted for the IPI score [ 34 – 39 , 41 – 43 , 46 ] or age-adjusted IPI [ 44 , 48 , 49 ], some dichotomized the score and others used the individual components. Results were varying widely; in some studies both interim PET and (aa)IPI showed an independent association with PFS or EFS [ 42 , 48 ], others only for interim PET [ 34 , 37 , 39 , 41 , 44 , 53 ], or (aa)IPI [ 43 , 49 ] or no independent associations were found for both interim PET or (aa)IPI [ 35 , 36 , 38 , 46 ]. One could argue that reporting univariate HRs instead of multivariate HRs could result in an overestimation of the predictive value of interim PET.…”