Prognostic value of total lesion glycolysis of baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography in diffuse large B-cell lymphoma

Mingge Zhou, Yumei Chen, Honghui Huang, Xiang Zhou, Jianjun Liu, Gang Huang, Mingge Zhou, Yumei Chen, Honghui Huang, Xiang Zhou, Jianjun Liu, Gang Huang

Abstract

Purpose: We evaluated the prognostic value of total lesion glycolysis (TLG) measured in baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diffuse large B-cell lymphoma (DLBCL) treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).

Methods: A total of 91 patients with newly diagnosed DLBCL underwent 18F-FDG PET/CT scans before R-CHOP therapy. Metabolic tumor volume (MTV) was measured with the marginal threshold of normal liver mean standard uptake value (SUVmean) plus 3 standard deviations (SD). TLG was the sum of the products of MTV and SUVmean in all measured lesions. The predictive value was estimated by Log-rank test and Cox-regression analysis.

Results: Median follow-up was 30 months (range, 5-124 months). The 5-year estimated progression-free survival (PFS) of the low and high TLG group were 83% and 34%, respectively (p<0.001). The 5-year overall survival (OS) of the same groups were 92% and 67%, respectively (p<0.001). Patients with high TLG level were more likely to relapse than those with low TLG level even though they had got complete or partial remission in R-CHOP therapy (40% versus 9%, p=0.012). Multivariate analysis revealed TLG was the only independent predictor for PFS (Hazard ratio=5.211, 95% confidence interval=2.210-12.288, p<0.001) and OS (Hazard ratio=9.136, 95% confidence interval=1.829-45.644, p=0.002). Other factors including MTV, National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and Ann Arbor Stage were not independently predictive for survivals.

Conclusion: Baseline TLG is the only independent predictor for PFS and OS in DLBCL patients treated with R-CHOP therapy.

Keywords: DLBCL; MTV; PET/CT; TLG; prognosis.

Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare that they have no conflicts of interest.

Figures

Figure 1. Estimates of PFS and OS…
Figure 1. Estimates of PFS and OS according to parameters in baseline PET/CT
A, C, E. Kaplan-Meier estimates of PFS; B, D., E Kaplan-Meier estimates of OS. High, above the cutoff values from ROC analysis; low, at or below the cutoff values from ROC analysis.
Figure 2. Relapse or progression in patients…
Figure 2. Relapse or progression in patients achieving remission in R-CHOP therapy
High, above the median values; low, at or below the median values.
Figure 3. 18 F-FDG PET images of…
Figure 3. 18F-FDG PET images of a recurrent case
The baseline PET image shows high tumor burden with TLG of 1244g A. Although no hyper-metabolic lesions were seen on PET images after 6 cycles of R-CHOP therapy B., the patient experienced relapse nine months after the R-CHOP therapy C.

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