Abstract:
Objective To investigate the prognostic prediction value of baseline 18F-fluorodeoxyglucose (FDG) PET parameters in diffuse large B-cell lymphoma (DLBCL) and establish a predictive model for stratifying patient risk.
Methods A retrospective analysis was conducted on the clinical and imaging data from 244 patients with DLBCL who underwent 18F-FDG PET scans and were confirmed by histopathological examination from July 2013 to May 2018 at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School (183 cases), and the First Affiliated Hospital with Nanjing Medical University (61 cases). The study included 137 males and 107 females, with an age range of 19–86 years (median age of 49). Clinical data were collected, including gender, age, B symptoms, Eastern Cooperative Oncology Group physical state score, lactate dehydrogenase (LDH) levels, bulky disease, bone marrow involvement, and histopathological subtypes. LIFEx software was used to calculate the maximum standardized uptake value (SUVmax), the total metabolic tumor volume (TMTV), the total lesion glycolysis (TLG), and the maximum distance between two lesions (Dmax). On the basis of the cut-off values determined by the receiver operating characteristic (ROC) curve, a prognostic prediction model for DLBCL was constructed using Dmax, SUVmax, TMTV, and age. The patients were assigned to low-, intermediate-, and high-risk groups on the basis of a scoring system where each of the four independent risk factors (SUVmax, TMTV, Dmax, and age) was given a score of 1, resulting in scores of 0 for the low-risk group, 1 or 2 for the intermediate-risk group, and 3 or 4 for the high-risk group. Kaplan-Meier survival analysis was employed to evaluate patient survival, with differences between groups compared using Log-rank test. Univariate and multivariate Cox proportional risk regression analyses were performed to identify independent risk factors for predicting DLBCL, and a predictive model was constructed on the basis of the results of multivariate Cox proportional risk regression.
Results The DLBCL patients were categorized into groups with SUVmax<21.5 and SUVmax≥21.5 groups, TMTV<198.4 cm3 and TMTV≥198.4 cm3 groups, TLG<2088.1 g and TLG≥2088.1 g groups, and Dmax<51.4 cm and Dmax≥51.4 cm groups. Univariate Cox proportional risk regression analysis revealed that age, LDH levels, bulky disease, Dmax, SUVmax, TMTV, and TLG are prognostic factors for progression-free survival (PFS) rate (HR=1.534–6.944, all P<0.05). Age, bulky disease, Dmax, SUVmax, TMTV, and TLG are prognostic factors for overall survival (OS) rate (HR=1.551–7.456, all P<0.05). Multivariate Cox proportional risk regression analysis indicated that Dmax, SUVmax, TMTV, and age are independent prognostic factors for PFS rate (HR=5.194, 1.599, 2.013, 1.533; all P<0.05) and OS rate (HR=5.027, 1.521, 2.400, 1.731; all P<0.05). The Kaplan-Meier survival analysis showed statistically significant differences in the PFS and OS rates between DLBCL patients with SUVmax<21.5 and those with SUVmax≥21.5 groups (PFS: 57.4% vs. 44.7%, OS: 69.5% vs. 56.3%), DLBCL patients with TMTV<198.4 cm3 and those with TMTV≥198.4 cm3 groups (PFS: 72.5% vs. 32.3%, OS: 82.5% vs. 46.0%), DLBCL patients with Dmax<51.4 cm and those with Dmax≥51.4 cm groups (PFS: 80.5% vs. 18.0%, OS: 88.0% vs. 35.1%), DLBCL patients younger than 60 years and those aged 60 years or older (PFS: 60.6% vs. 42.7%, OS: 73.2% vs. 53.8%) (χ2=5.403–99.393, all P<0.05). Furthermore, the differences in PFS rates (93.3% vs. 65.9% vs. 10.5%) and OS rates (100.0% vs. 77.5% vs. 25.0%) among patients categorized into low-, intermediate-, and high-risk groups (n=30, 138, 76) were statistically significant (χ2=87.429, 74.416; both P<0.001).
Conclusions Dmax, SUVmax, TMTV, and age are independent predictive factors for PFS rate and OS in patients with DLBCL. The predictive model can accurately predict the prognosis of these patients and effectively guide personalized treatment strategies.
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