High metabolic heterogeneity on baseline 18FDG-PET/CT scan as a poor prognostic factor for newly diagnosed diffuse large B-cell lymphoma

Senjo, Hajime; Hirata, Kenji; Izumiyama, Koh; Minauchi, Koichiro; Tsukamoto, Eriko; Itoh, Kazuyoshi; Kanaya, Minoru; Mori, Akio; Ota, Shuichi; Hashimoto, Daigo; Teshima, Takanori

doi:10.1182/bloodadvances.2020001816

Cited by 34 publications

(35 citation statements)

References 34 publications

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“…Interestingly, estimations of intertumoral metabolic heterogeneity (MH) were shown to be an accurate predictor of poor outcomes in patients with higher MTV, coinciding with shorter PFS and OS. Models taking into account both MTV and MH improved upon MTV alone as a predictor for PFS and OS [81,82]. Similar results were found in primary mediastinal B-cell lymphoma (PMBCL), where a model combining both MH and TLG was found to be a more effective predictive tool than models using only one of these parameters [83].…”

Section: [ 18 F]fdg Pet/ctsupporting

confidence: 55%

Non-Hodgkin Lymphoma Metabolism

Kirsch

Chang

Betenbaugh

et al. 2021

Advances in Experimental Medicine and Biology

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Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of lymphoid neoplasms with different biological characteristics. About 90% of all lymphomas in the United States originate from B lymphocytes, while the remaining originate from T cells [1]. The treatment of NHLs depends on the neoplastic histology and stage of the tumor, which will indicate whether radiotherapy, chemotherapy, or a combination is the best suitable treatment [2]. The American Cancer Society describes the staging of lymphoma as follows: Stage I is lymphoma in a single node or area. Stage II is when that lymphoma has spread to another node or organ tissue. Stage III is when it has spread to lymph nodes on two sides of the diaphragm. Stage IV is when cancer has significantly spread to organs outside the lymph system. Radiation therapy is the traditional therapeutic route for localized follicular and mucosa-associated lymphomas. Chemotherapy is utilized for the treatment of large-cell lymphomas and high-grade lymphomas [2]. However, the treatment of indolent lymphomas remains problematic as the patients often have metastasis, for which no standard approach exists [2].

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Section: [ 18 F]fdg Pet/ctsupporting

confidence: 55%

Non-Hodgkin Lymphoma Metabolism

Kirsch

Chang

Betenbaugh

et al. 2021

Advances in Experimental Medicine and Biology

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“…However, the study is limited to HL with mediastinal involvement with again small numbers of events. Senjo et al demonstrated that a high metabolic heterogeneity (MH) was a predictor of 5-year PFS and OS in DLBCL across both training (n = 86) and validation cohorts (n = 64) treated at two centres [41]. They found that MH remained a significant predictor for 5-year OS for both cohorts when analysed in multivariate analysis with an ECOG score of >2, and an LDH with a relative risk of 4.75 (95% CI 1.25-18.1) and relative risk of 4.92 (95% CI 1.09-17.03) in the training and validation groups, respectively.…”

Section: Textural and Shape Analysis For Outcome Predictionmentioning

confidence: 99%

Baseline PET/CT imaging parameters for prediction of treatment outcome in Hodgkin and diffuse large B cell lymphoma: a systematic review

Frood

Combes

Tsoumpas

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose To systematically review the literature evaluating clinical utility of imaging metrics derived from baseline fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for prediction of progression-free (PFS) and overall survival (OS) in patients with classical Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). Methods A search of MEDLINE/PubMed, Web of Science, Cochrane, Scopus and clinicaltrials.gov databases was undertaken for articles evaluating PET/CT imaging metrics as outcome predictors in HL and DLBCL. PRISMA guidelines were followed. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results Forty-one articles were included (31 DLBCL, 10 HL). Significant predictive ability was reported in 5/20 DLBCL studies assessing SUVmax (PFS: HR 0.13–7.35, OS: HR 0.83–11.23), 17/19 assessing metabolic tumour volume (MTV) (PFS: HR 2.09–11.20, OS: HR 2.40–10.32) and 10/13 assessing total lesion glycolysis (TLG) (PFS: HR 1.078–11.21, OS: HR 2.40–4.82). Significant predictive ability was reported in 1/4 HL studies assessing SUVmax (HR not reported), 6/8 assessing MTV (PFS: HR 1.2–10.71, OS: HR 1.00–13.20) and 2/3 assessing TLG (HR not reported). There are 7/41 studies assessing the use of radiomics (4 DLBCL, 2 HL); 5/41 studies had internal validation and 2/41 included external validation. All studies had overall moderate or high risk of bias. Conclusion Most studies are retrospective, underpowered, heterogenous in their methodology and lack external validation of described models. Further work in protocol harmonisation, automated segmentation techniques and optimum performance cut-off is required to develop robust methodologies amenable for clinical utility.

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“…The simplest example may be to enclose the tumour with ROI, create a histogram of voxel values within the ROI, and calculate mean, standard deviation, energy, entropy, kurtosis, skewness, and so on. A cumulative histogram of SUV and its area under the curve, abbreviated as AUC-CSH, is also commonly used for this purpose [ 50 ].…”

Section: Basic Concepts For Quantitative Fdg Pet Assessmentmentioning

confidence: 99%

Quantitative FDG PET Assessment for Oncology Therapy

Hirata

Tamaki

2021

Cancers

Self Cite

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Positron emission tomography (PET) has unique characteristics for quantitative assessment of tumour biology in vivo. Accumulation of F-18 fluorodeoxyglucose (FDG) may reflect tumour characteristics based on its metabolic activity. Quantitative assessment of FDG uptake can often be applied for treatment monitoring after chemotherapy or chemoradiotherapy. Numerous studies indicated biochemical change assessed by FDG PET as a more sensitive marker than morphological change estimated by CT or MRI. In addition, those with complete metabolic response after therapy may show better disease-free survival and overall survival than those with other responses. Assessment of metabolic change may be performed using absolute FDG uptake in the tumour (standardized uptake value: SUV). In addition, volumetric parameters such as metabolic tumour volume (MTV) have been introduced for quantitative assessment of FDG uptake in tumour. More recently, radiomics approaches that focus on image-based precision medicine have been applied to FDG PET, as well as other radiological imaging. Among these, texture analysis extracts intratumoral heterogeneity on a voxel-by-voxel basis. Combined with various machine learning techniques, these new quantitative parameters hold a promise for assessing tissue characterization and predicting treatment effect, and could also be used for future prognosis of various tumours, although multicentre clinical trials are needed before application in clinical settings.

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High metabolic heterogeneity on baseline 18FDG-PET/CT scan as a poor prognostic factor for newly diagnosed diffuse large B-cell lymphoma

Cited by 34 publications

References 34 publications

Non-Hodgkin Lymphoma Metabolism

Non-Hodgkin Lymphoma Metabolism

Baseline PET/CT imaging parameters for prediction of treatment outcome in Hodgkin and diffuse large B cell lymphoma: a systematic review

Quantitative FDG PET Assessment for Oncology Therapy

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