Value of total lesion glycolysis and cell-of-origin subtypes for prognostic stratification of diffuse large B-cell lymphoma patients

Abstract

Background: This study aimed to explore the added prognostic value of baseline metabolic volumetric parameters and cell of origin subtypes to the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) in nodal diffuse large B-cell lymphoma (DLBCL) patients.Methods: A total of 184 consecutive de novo nodal DLBCL patients who underwent baseline positron emission tomography/computed tomography (PET/CT) were included in this study. Kaplan-Meier estimates were generated to evaluate the clinical, biological, and PET/CT parameters' prognostic value. The Cox proportional hazards model was performed to examine the potential independent predictors for progressionfree survival (PFS) and overall survival (OS).Results: With a median follow-up of 35 months, the 3-year PFS and OS were 65.2% and 73.0%, respectively. In univariate analysis, total lesion glycolysis (TLG), cell-of-origin subtypes, and NCCN-IPI were both PFS and OS predictors. High TLG (≥1,852), non-germinal center B (non-GCB), as well as high NCCN-IPI (≥4), were shown to be independently significantly associated with inferior PFS and OS after multivariate analysis. Based on the number of risk factors (high TLG, non-GCB, and high NCCN-IPI), a revised risk model was designed, and the participants were divided into four risk groups with very different outcomes, in which the PFS rates were 89.7%, 66.2%, 51.7%, and 26.7% (χ 2 =30.179, P<0.001), and OS rates were 93.1%, 73.8%, 56.7%, and 43.3%, respectively (χ 2 =23.649, P<0.001), respectively. Compared with the NCCN-IPI alone, the revised risk model showed a stronger ability to reveal further discrimination among subgroups, especially for participants with very unfavorable survival outcomes (PFS: χ 2 =9.963, P=0.002; OS: χ 2 =4.166, P=0.041, respectively). Conclusions:The TLG, cell-of-origin subtypes, and NCCN-IPI are independent prognostic survival factors in DLBCL patients. Moreover, the revised risk model composed of the number of risk factors (high TLG, non-GCB, and high NCCN-IPI) can stratify patients better than the NCCN-IPI, especially for patients at high risk, which suggests its potential integration into decision making for personalized medicine.

Prognostic value of 18F-FDG PET/CT tumor metabolic parameters and Ki-67 in pre-treatment diffuse large B-cell lymphoma

“…This result is consistent with the findings of prior research ( 31 , 32 ). Jiang et al discovered that TLG ≥1,852 cm 3 was associated with an adverse prognosis ( 8 , 33 ), and our study had a similar cut-off value for TLG (≥1,854.00 cm 3 ). However, previous studies only included one of these, and did not consider the correlation between TLG and TMTV ( 8 , 33 ).…”

“…Jiang et al discovered that TLG ≥1,852 cm 3 was associated with an adverse prognosis ( 8 , 33 ), and our study had a similar cut-off value for TLG (≥1,854.00 cm 3 ). However, previous studies only included one of these, and did not consider the correlation between TLG and TMTV ( 8 , 33 ). The advantage of this study is that multivariate regression model was developed separately for each of the associated indicators, and the indicator correction was more comprehensive at the level of available data.…”

“…However, adverse outcomes have yet to be found in a sufficient number of patients ( 7 ). Other prognostic factors, such as the germinal center B-cell (GCB) and non-GCB ( 8 ) or dual expression (DE) of MYC and BCL2 ( 9 , 10 ) and Ki-67 ( 11 ), have been recently identified, but their value in guiding treatment decisions is still debatable. Therefore, new strategies are urgently needed to better evaluate the prognosis of DLBCL.…”

Precision of quantitative parameters of 18F-FDG PET/CT in a rabbit VX2 tumor model

“…TLG was considered a predictor of clinical efficacy value in some literatures (30)(31)(32). To the best of our knowledge, no previous TLG study has been published in animal PET/ CT imaging for assessment of tumor response to therapy.…”

Predicting diffuse large B-cell lymphoma outcomes with lesion-to-liver maximum standardized uptake value for interim-treatment and end-of-treatment positron emission tomography-computed tomography

“…Standard chemoimmunotherapy for this condition consists of 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone ( 1 ). The addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy has resulted in a major improvement in survival outcomes in patients with DLBCL ( 2 , 3 ). Accurately assessing the disease status and response to antilymphoma therapy has important clinical implications for patient outcomes and can guide subsequent treatment.…”