Abstract
PurposeThis study aimed to develop a novel analytic approach based on 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) radiomic signature (RS) and International Prognostic Index (IPI) to predict the progression-free survival (PFS) and overall survival (OS) of patients with diffuse large B-cell lymphoma (DLBCL).MethodsWe retrospectively enrolled 152 DLBCL patients and divided them into a training cohort (n = 100) and a validation cohort (n = 52). A total of 1245 radiomic features were extracted from the total metabolic tumor volume (TMTV) and the metabolic bulk volume (MBV) of pre-treatment PET/CT images. The least absolute shrinkage and selection operator (LASSO) algorithm was applied to develop the RS. Cox regression analysis was used to construct hybrid nomograms based on different RS and clinical variables. The performances of hybrid nomograms were evaluated using the time-dependent receiver operator characteristic (ROC) curve and the Hosmer–Lemeshow test. The clinical utilities of prediction nomograms were determined via decision curve analysis. The predictive efficiency of different RS, clinical variables, and hybrid nomograms was compared.ResultsThe RS and IPI were identified as independent predictors of PFS and OS, and were selected to construct hybrid nomograms. Both TMTV- and MBV-based hybrid nomograms had significantly higher values of area under the curve (AUC) than IPI in training and validation cohorts (all P < 0.05), while no significant difference was found between TMTV- and MBV-based hybrid nomograms (P > 0.05). The Hosmer–Lemeshow test showed that both TMTV- and MBV-based hybrid nomograms calibrated well in the training and validation cohorts (all P > 0.05). Decision curve analysis indicated that hybrid nomograms had higher net benefits than IPI.ConclusionThe hybrid nomograms combining RS with IPI could significantly improve survival prediction in DLBCL. Radiomic analysis on MBV may serve as a potential approach for prognosis assessment in DLBCL.Trial registrationNCT04317313. Registered March 16, 2020. Public site: https://clinicaltrials.gov/ct2/show/NCT04317313
Highlights
Diffuse large B-cell lymphoma (DLBCL) represents the most common type of lymphoid neoplasm [1]
metabolic bulk volume (MBV)- or total metabolic tumor volume (TMTV)-based hybrid nomograms for progression-free survival (PFS) and overall survival (OS) prediction (MBVHNPFS, TMTV-HNPFS, MBV-HNOS, and TMTV-HNOS) were established on the basis of the regression coefficient of each variable that remained significant in the multivariate Cox analysis [29]
Our results demonstrated that radiomic analysis on MBV and TMTV both perform well in predicting survival, which is in line with previous reports [13, 14]
Summary
Diffuse large B-cell lymphoma (DLBCL) represents the most common type of lymphoid neoplasm [1]. Several studies have indicated that PET semi-quantitative parameters, maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), and total lesion glycolysis (TLG), might be independent prognostic factors in DLBCL [8,9,10]. Those parameters are only used to evaluate the gross tumor metabolism, which cannot fully depict the subtle metabolic heterogeneity within a targeted lesion. PET-based radiomics has been introduced as an innovative image analysis that can capture intratumoral metabolic heterogeneity and allow accurate prediction of clinical outcome in various malignancies, such as breast cancer, non-small cell lung cancer, and lymphoma [11,12,13]. It remains unclear whether PET-based RS could add more prognostic values to the IPI in DLBCL
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