Abstract
IntroductionIn the era of rituximab, the NCCNIPI is widely used in clinical practice as a tool for the prognosis and risk stratification of diffuse large B-cell lymphoma (DLBCL). In recent years, FDG PET/CT has also shown unique prognostic value. We try to further confirm the prognostic role of metabolic parameters in the overall and subgroups patients.MethodsWe retrospectively analysed 87 DLBCL patients who underwent baseline FDG PET/CT and followed the R-CHOP or R-CHOP-like strategy. The clinical parameters and PET-related metabolic parameters were evaluated.ResultsFor all patients, the 2-year PFS rate was 65.5% and the 2-year OS rate was 66.7%. According to Cox multivariate analysis, a high NCCNIPI score (4–8 points) and an MTV greater than 64.1 cm3 (defined by ROC) were independent prognostic factors for PFS and OS. The patients were divided into low, low-intermediate, high-intermediate and high-risk groups by NCCNIPI score. The 2-year PFS rates in each group were 90.9%, 71.3%, 33.2% and 16.7%, and the 2-year OS rates were 100%, 81.6%, 48.4% and 16.7%. In the subsequent subgroup analysis by MTV, it could further stratified low-intermediate and high-intermediate NCCNIPI groups, the P value was 0.068 and 0.069 for PFS, 0.078 and 0.036 for OS.ConclusionsMTV, as a tumor metabolic volume parameter, and the NCCNIPI score were independent predictors of prognosis in general DLBCL patients. In the low-intermediate and high-intermediate NCCNIPI subgroup, we further confirm the risk stratification abilities of MTV, which could add the prognostic value of NCCNIPI.
Highlights
In the era of rituximab, the NCCNIPI is widely used in clinical practice as a tool for the prognosis and risk stratification of diffuse large B-cell lymphoma (DLBCL)
Since 1993, the International Prognostic Index (IPI) has Annals of Nuclear Medicine (2021) 35:24–30 been used to predict the prognosis of aggressive NHL treated with doxorubicin-based therapy; this index is based on five stratified clinical characteristics: age, Ann Arbor stage, lactate dehydrogenase (LDH), number of extranodal sites, and Eastern Cooperative Oncology Group (ECOG) performance status [4]
The inclusion criteria were as follows: 1. all patients were older than 18 years; 2. were new cases of lymphoma; 3. all patients were confirmed to have DLBCL by pathology and immunohistochemistry; 4. all patients underwent baseline whole body PET/CT glucose metabolism imaging within 2 weeks before treatment and accepted the R-CHOP regimen or R-CHOP-like regimen as a first-line treatment; and 5. the effective follow-up time was more than 24 months
Summary
In the era of rituximab, the NCCNIPI is widely used in clinical practice as a tool for the prognosis and risk stratification of diffuse large B-cell lymphoma (DLBCL). In the subsequent subgroup analysis by MTV, it could further stratified low-intermediate and high-intermediate NCCNIPI groups, the P value was 0.068 and 0.069 for PFS, 0.078 and 0.036 for OS. In the low-intermediate and high-intermediate NCCNIPI subgroup, we further confirm the risk stratification abilities of MTV, which could add the prognostic value of NCCNIPI. Though the volume parameter shows its prognostic ability in overall DLBCL patients, according to our knowledge, and further stratification by MTV in subgroup has not been confirmed and studied, the aim of our study was to provide evidence to support this point
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