Abstract
BackgroundThe prognostic value of 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma (ENKTL) is not well established. We aimed to develop nomograms for individualized estimates of progression-free survival (PFS) and overall survival (OS) in patients with ENKTL using 18F-FDG PET/CT parameters and clinical parameters.MethodsA total of 171 patients with newly diagnosed ENKTL undergoing 18F-FDG PET/CT scanning were retrospectively analyzed. Nomograms were constructed according to multivariate Cox proportional hazards regression. The predictive and discriminatory capacities of the nomograms were then measured using the concordance index (C-index), calibration plots, and Kaplan-Meier curves. The C-index, the area under receiver operating characteristic (ROC) curve (AUC), and decision curve analysis (DCA) were used to contrast the predictive and discriminatory capacities of the nomograms against with the International Prognostic Index (IPI) and Korean Prognostic Index (KPI).ResultsMultivariate analysis demonstrated that pretreatment SUVmax≥9.5, disease stage II and III-IV, elevated lactate dehydrogenase (LDH), and elevated β2-microglobulin (β2-MG) had the strongest association with unfavorable PFS and OS. In addition, hemoglobin (Hb) < 120 g/L had a tendency to be associated with PFS. Both nomogram models incorporated SUVmax, Ann Arbor stage, LDH, and β2-MG. The PFS nomogram also included Hb. The nomograms showed good prediction accuracies, with the C-indexes for PFS and OS were 0.729 and 0.736, respectively. The calibration plots for 3-year and 5-year PFS/OS reported good consistency between predicted and observed probabilities for survival time. The PFS and OS were significantly different according to tertiles of nomogram scores (p < 0.001). The C-index and AUCs of the nomograms were higher than that of IPI and KPI. Moreover, DCA showed that the predictive accuracy of the nomograms for PFS and OS were both higher than that of IPI and KPI.ConclusionsThis study established nomograms that incorporate pretreatment SUVmax and clinical parameters, which could be effective tools for individualized prognostication of both PFS and OS in patients with newly diagnosed ENKTL.
Highlights
The prognostic value of 18F-FDG Positron emission tomography/computed tomography (PET/CT) in extranodal natural killer/T-cell lymphoma (ENKTL) is not well established
Extranodal natural killer/T-cell lymphoma (ENKTL) is recognized as a distinct pathological entity classified by the World Health Organization (WHO) classification of lymphoid tumors [1]
The results showed that disease stages II and III-IV, presence of B symptoms, elevated lactate dehydrogenase (LDH), elevated β2-MG, Hb < 120 g/L, Maximum standardized uptake value (SUVmax)≥9.5, interim PET/CT Deauville score (DS) score 4/5, and end-of-treatment PET/ CT DS score 4/5 were significant factors for unfavorable progression-free survival (PFS) and overall survival (OS)
Summary
The prognostic value of 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma (ENKTL) is not well established. The C-index, the area under receiver operating characteristic (ROC) curve (AUC), and decision curve analysis (DCA) were used to contrast the predictive and discriminatory capacities of the nomograms against with the International Prognostic Index (IPI) and Korean Prognostic Index (KPI). Extranodal natural killer/T-cell lymphoma (ENKTL) is recognized as a distinct pathological entity classified by the World Health Organization (WHO) classification of lymphoid tumors [1]. It is a rare subtype of nonHodgkin lymphoma in Europe and North America; it is much more common in Asia and South America [2]. The predictive accuracy of those prognostic scoring systems has been reported to be limited for ENKTL [8, 9]
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