F-FDG-PET dissemination features in diffuse large B cell lymphoma are prognostic of outcome.

Fiche publication

Date publication

juin 2019

Journal

Journal of nuclear medicine : official publication, Society of Nuclear Medicine

Auteurs

Membres identifiés du Cancéropôle Est :
Dr CASASNOVAS Olivier

Tous les auteurs :
Cottereau AS, Nioche C, Dirand AS, Clerc J, Morschhauser F, Casasnovas O, Meignan MA, Buvat I

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/31201248

Résumé

We assessed the prognostic value of new radiomic features (RF) characterizing the lesion dissemination in baseline F-FDG PET and tested whether combining them with baseline metabolic tumour volume (MTV) could improve prediction of progression free survival (PFS) and overall survival (OS) in DLBCL patients. From the LNH073B trial (NCT00498043), patients with an advanced stage DLCBL and F-FDG PET/CT images available for review were selected. MTV and several RF, including the distance between the two lesions that were the furthest apart (Dmaxpatient) were calculated. Receiver operator characteristics analysis were used to determine the optimal cut-off for quantitative variables and Kaplan-Meier survival analyses were performed. With a median age of 46 years, 95 patients were enrolled, half of them treated with R-CHOP14 (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone), the others with R-ACVBP (rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone), with no significant impact on outcome. Median MTV and Dmaxpatient were 375 cm and 45 cm respectively. The median follow-up was 44 months. High MTV and Dmaxpatient were adverse factors for PFS ( = 0.027 and = 0.0003 respectively) and for OS ( = 0.0007, = 0.0095). In multivariate analysis, only Dmaxpatient was significantly associated with PFS ( = 0.0014) whereas both factors remained significant for OS ( = 0.037 and = 0.0029 respectively). Combining MTV (>384 cm) and Dmaxpatient (>58 cm) yielded 3 risk groups for PFS ( = 0.0003) and OS ( = 0.0011): high with 2 adverse factors (4y-PFS and OS of 50% and 53%, = 18), low risk with no adverse factor (94% and 97%, = 36), and an intermediate category with one adverse factor (73% and 88%, = 41). Combining MTV with a parameter reflecting the tumour burden dissemination further improves DLBCL patient risk stratification at staging.