성균관의대 / 진현, 이경한*
Abstract
Purpose: Accurate risk stratification can improve lymphoma management, but current volumetric 18F-fluorodeoxyglucose (FDG) indicators require time-consuming segmentation of all lesions in the body. Herein, we investigated the prognostic values of readily obtainable metabolic bulk volume (MBV) and bulky lesion glycolysis (BLG) that measure the single largest lesion.
Methods: The study subjects were a homogeneous cohort of 242 newly diagnosed stage II or III diffuse large B-cell lymphoma (DLBCL) patients who underwent first-line R-CHOP treatment. Baseline PET/CT was retrospectively analyzed for maximum transverse diameter (MTD), total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), MBV, and BLG. Volumes were drawn using 30% SUVmax as threshold. Kaplan-Meier survival analysis and the Cox proportional hazards model assessed the ability to predict overall survival (OS) and progression-free survival (PFS).
Results: During a median follow-up period of 5.4 years (maximum of 12.7 years), events occurred in 85 patients, including progression, relapse, and death (65 deaths occurred at a median of 17.6 months). Receiver operating characteristic (ROC) analysis identified an optimal TMTV of 112 cm3, MBV of 88 cm3, TLG of 950, and BLG of 750 for discerning events. Patients with high MBV were more likely to have stage III disease; worse ECOG performance; higher IPI risk score; increased LDH; and high SUVmax, MTD, TMTV, TLG, and BLG. Kaplan-Meier survival analysis showed that high TMTV (p = 0.005 and < 0.001), MBV (both p < 0.001), TLG (p < 0.001 and 0.008), and BLG (p = 0.018 and 0.049) were associated with significantly worse OS and PFS. On Cox multivariate analysis, older age (> 60 years; HR, 2.74; 95% CI, 1.58-4.75; p < 0.001) and high MBV (HR, 2.74; 95% CI, 1.05-6.54; p = 0.023) were independent predictors of worse OS. Older age (hazard ratio [HR], 2.90; 95% CI, 1.74-4.82; p < 0.001) and high MBV (HR, 2.36; 95% CI, 1.15-6.54; p = 0.032) were also independent predictors of worse PFS. Furthermore, among subjects ≤60 years, high MBV remained the only significant independent predictor of worse OS (HR, 4.269; 95% CI, 1.03-17.76; p = 0.046) and PFS (HR, 6.047; 95% CI, 1.73-21.11; p = 0.005). Among subjects with stage III disease, only greater age (HR, 2.540; 95% CI, 1.22-5.30; p = 0.013) and high MBV (HR, 6.476; 95% CI, 1.20-31.9; p = 0.030) were significantly associated with worse OS, while greater age was the only independent predictor of worse PFS (HR, 6.145; 95% CI, 1.10-4.17; p = 0.024).
Conclusions: MBV easily obtained from the single largest lesion may provide a clinically useful FDG volumetric prognostic indicator in stage II/III DLBCL patients treated with R-CHOP.
Affiliations
Hyun Jin 1, Myung Jin 2, Chae Hong Lim 3, Joon Young Choi 4, Seok-Jin Kim 5, Kyung-Han Lee 4
1Sungkyunkwan University School of Medicine, Suwon, Republic of Korea.
2Department of Electrical and Computer Engineering, Seoul, Republic of Korea.
3Department of Nuclear Medicine, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
4Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
5Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
편집위원
림프종 (diffuse large B-cell lymphoma) 환자에서 FDG PET/CT를 시행하면 어렵지 않게 MBV (metabolic bulk volume)을 계산할 수 있으며, 이 값이 환자의 생존률에 부정적 영향을 미침을 확인한 임상연구임. 해당 연구결과는 림프종환자의 예후 예측이 도움이 되어, 종양내과 의사 및 핵의학 임상가에게 유용한 정보를 제공할 것으로 생각됨.
2023-08-08 14:18:40
편집위원2
R-CHOP 치료를 받는 stage II/III diffuse large B-cell lymphoma 환자에서 FDG PET/CT를 이용하여 측정한 metabolic bulk volume과 bulky lesion glycolysis의 예후적 가치로서 손쉽게 측정할 수 있는 metabolic bulk volume이 이질적인 환자군의 생존 예측에 활용할 수 있음을 보여줌
2023-08-08 15:46:24