Prognostic Role of Pre-Treatment Metabolic Parameters and Sarcopenia Derived by 2-[18F]-FDG PET/CT in Elderly Mantle Cell Lymphoma

Abstract

The goal of this retrospective study was to analyze and compare the prognostic role of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (2-[18F]-FDG PET/CT) features and sarcopenia, estimated by CT of PET in elderly (≥65 years) Mantle Cell Lymphoma (MCL). We recruited 53 patients, who underwent pre-treatment 2-[18F]-FDG PET/CT and end-of-treatment PET/CT, and the main semiquantitative parameters were calculated. Sarcopenia was measured as skeletal muscle index (SMI, cm2/m2) and derived by low-dose PET/CT images at the L3 level. Specific cut-offs for SMI were calculated by receiver operator curve and divided by gender. Metabolic response was evaluated at end-of-treatment PET/CT, applying the Deauville score. Progression Free Survival (PFS) and Overall Survival (OS) were calculated for the whole population and for different subgroups, defined as per different sarcopenia cut-off levels. The specific cut-offs to define sarcopenia were 53 cm2/m2 for male and 45.6 cm2/m2 for female. Thirty-two (60%) patients were defined as sarcopenic. The 3-year and 5-year PFS rates were 29% and 23%, while the 3-year and 5-year OS rates were 43% and 33%. Metabolic response, total metabolic tumor volume (tMTV), total lesion glycolysis (tTLG) and sarcopenia were independent prognostic factors for PFS. Considering OS, no variable was significantly associated. Combination between PET features and sarcopenia may help to predict PFS.

Emerging Role of FAPI PET Imaging for the Assessment of Benign Bone and Joint Diseases

“…The most common tracer used to perform such a diagnostic procedure is 18 F-fluorodeoxyglucose ([ 18 F]FDG), which has the ability to reveal hypermetabolic lesions based on their increased glycolytic metabolism. As a consequence, [ 18 F]FDG PET/CT has proven its role to assess neoplastic disease both in staging and restaging settings [ 1 , 2 , 3 , 4 , 5 ]. However, its usefulness for the evaluation of inflammatory and infectious diseases has also emerged, in particular in the last decade [ 6 , 7 , 8 , 9 ].…”

Prevalence and prognostic value of baseline sarcopenia in hematologic malignancies: a systematic review

“…In this review, we found that older people had inferior survival outcomes compared to non-elderly sarcopenic patients (37). Aging and co-morbidities could increase the risk of side effects after anti-tumor therapy (26,27). Elderly patients are often ineligible or hard to treat in standard chemotherapy (24).…”

“…When we excluded the study by Ferraro et al (47), the heterogeneity of pooled OS decreased significantly [pooled HR 1.955, 95% CI (1.562-2.447), I 2 = 36.9%, 2389 patients, Figure S6]. When we excluded three of the articles (26,37,47), there was an apparent decrease in the heterogeneity of pooled PFS [pooled HR 1.802, 95% CI (1.497-2.170), I 2 = 29.8%, 1671 patients, Figure S7].…”

“…Sarcopenia has been associated with worse prognosis and increased treatment toxicities in neoplastic patients (14), such as esophagogastric, colorectal, breast, lung, liver, and renal cell cancer (15)(16)(17)(18)(19)(20)(21)(22)(23). Studies about sarcopenia's predictive value in hematologic malignancies are increasing (9,(24)(25)(26)(27)(28)(29)(30). However, the findings present significant disagreement.…”

Could [18F]FDG PET/CT or PET/MRI Be Useful in Patients with Skull Base Osteomyelitis?

“…18 F-fluorodeoxyglucose ([ 18 F]FDG) is the most common radiotracer used to perform positron emission tomography/CT (PET/CT) and PET/MRI. At first, this tracer was used mainly for the assessment of neoplastic diseases, given its ability to detect hypermetabolic lesions on the basis of their glycolytic metabolism [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. However, high glucose metabolism characterizes also activated inflammatory cells, and the use of [ 18 F]FDG PET has emerged for the evaluation of infectious and inflammatory diseases [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”