[¹⁸F]‐FDG PET radiomic model as prognostic biomarker in diffuse large B‐cell lymphoma

Abstract

To evaluate the association between radiomic features (RFs) extracted from 18F‐FDG PET/CT (18F‐FDG‐PET) with progression‐free survival (PFS) and overall survival (OS) in diffuse large‐B‐cell lymphoma (DLBCL) patients eligible to first‐line chemotherapy. DLBCL patients who underwent 18F‐FDG‐PET prior to first‐line chemotherapy were retrospectively analyzed. RFs were extracted from the lesion showing the highest uptake. A radiomic score to predict PFS and OS was obtained by multivariable Elastic Net Cox model. Radiomic univariate model, clinical and combined clinical‐radiomic multivariable models to predict PFS and OS were obtained. 112 patients were analyzed. Median follow‐up was 34.7 months (Inter‐Quartile Range (IQR) 11.3–66.3 months) for PFS and 41.1 (IQR 18.4–68.9) for OS. Radiomic score resulted associated with PFS and OS (p < 0.001), outperforming conventional PET parameters. C‐index (95% CI) for PFS prediction were 0.67 (0.58–0.76), 0.81 (0.75–0.88) and 0.84 (0.77–0.91) for clinical, radiomic and combined clinical‐radiomic model, respectively. C‐index for OS were 0.77 (0.66–0.89), 0.84 (0.76–0.91) and 0.90 (0.81–0.98). In the Kaplan‐Meier analysis (low‐IPI vs. high‐IPI), the radiomic score was significant predictor of PFS (p < 0.001). The radiomic score was an independent prognostic biomarker of survival in DLBCL patients. The extraction of RFs from baseline 18F‐FDG‐PET might be proposed in DLBCL to stratify high‐risk versus low‐risk patients of relapse after first‐line therapy, especially in low‐IPI patients.

The Role of CT Radiomics Analysis in Predicting Overall Survival Following initial Chemotherapy for Diffuse Large B-cell Lymphoma

“…Additionally, ROC curves indicated that Rad-score predicted AUC and accuracy values of 3 and 5-year OS in the validation cohorts were 0.787 and 69.5%, respectively, 0.563 and 63.6%, respectively, with a signi cantly reduced AUC value for the latter. Travaini et al also reported that the Rad-score basing the baseline 18F-FDG-PET was an independent prognostic biomarker of survival in DLBCL patients, and the C-index of OS was 0.84 [24] .…”

“…Zhao et al [30] reported an accuracy of 76.3% in predicting 2-year OS of DLBCL patients based on a combined FDG-PET/CT clinical-radiomic model, and the prediction accuracy of the nomogram model in this study is close to theirs. Travaini et al [24] reported that a combined clinicalradiomic model based on FDG-PET/CT predicted that the C-index of OS in DLBCL patients with rst-line chemotherapy was 0.90. The accuracy of the nomogram model in this study is still a certain distance from theirs.…”