Predictive Significance of a New Prognostic Score for Patients With Diffuse Large B-Cell Lymphoma in the Interim-Positron Emission Tomography Findings

Abstract

We hypothesized that the objective treatment response of patients with diffuse large B-cell lymphoma (DLBCL) was affected by many factors such as pathophysiological, biological, and pharmaceutical mechanisms. This retrospective study aimed to evaluate the predictive significance of clinical prognostic factors and interim fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), and to find a new prognostic predictor significantly associated with DLBCL patients’ outcome. A total of 105 adult patients with DLBCL were reviewed. Each patient underwent an interim 18F-FDG PET/CT scan after the second chemotherapy cycle. The visual method based on the Deauville 5-point scale was used to evaluate the interim-PET/CT scans. The relationships among the prognostic factors, the 3-year progression-free survival (PFS) rate and overall survival (OS) rate were analyzed with Kaplan–Meier plots. The predictive value of the newly constructed prognostic score was analyzed with multivariate analysis (Cox proportional hazard regression model). The visual analysis showed statistically significant differences in both PFS and OS between the patients with a negative interim-PET/CT and those with a positive interim-PET/CT. Advanced age, advanced stage, and DLBCL subtype were also significantly associated with outcome. A new prognostic score that composed of the above 4 factors was obtained. New prognostic score stratified patients into 4 risk groups with 3-year PFS of 98.5%, 73.9%, 11.1%, and 0%, and 3-year OS of 100%, 91.3%, 55.6%, and 0% (P < 0.001 for PFS and OS). Multivariate analysis showed that the new prognostic score had the greatest ability to predict relapse (P < 0.001) and death (P < 0.001). In DLBCL patients, interim 18F-FDG PET/CT can provide significant independent prognostic information. Our work illustrates that the new prognostic score has the strongest potential for accurately prognostication, for stratification in clinical trials, and for design of novel strategies for DLBCL patients in the high-risk group.

Retrospective Analysis of a New Prognostic Score for Diffuse Large B-Cell Lymphoma Based on Interim Positron Emission Tomography-Computed Tomography

“…The present retrospective study was undertaken to confirm the clinical value of a new prognostic score described by Kong et al [8]. In the present study, patient age, the presence of extranodal extension, PET-CT results, the IPI score, and the new prognostic index were all associated with 3-year mortality status; only PET-CT results and the new prognostic index were associated with 3-year progression status.…”

“…In an effort to design a better prognostic system for DLBCL patients, the present study examined a new prognostic score based on interim PET-CT, age, pathological subtype, and Ann Arbor stage, designed by Kong et al [8]. In contrast to IPI status, which was not significantly associated with disease progression, the new prognostic score was predictive of the 3-year PFS; both IPI and the new prognostic score were predictive of the 3-year OS, which was similar to the value reported by Kong et al [8].…”

“…The new prognostic scoring system included the following scoring criteria as described by Kong et al [8]: age ≥60 years, positive interim PET-CT results, Ann Arbor stage III/IV, and a non-GCB pathological subtype. Each item was 1 point to determine the following risk groups: low risk (0–1 point), medium to low risk (2 points), medium to high risk (3 points), and high risk (4 points).…”

“…It was predictive of disease progression (HR 8.44; 95% CI 4.19–17.01) and death (HR 8.58; 95% CI 4.22–17.45) [8]. The present retrospective study was undertaken to confirm the clinical value of this new prognostic score and its association with various clinical features, histological characteristics, interim PET-CT, 3-year progression-free survival (PFS), 3-year OS, disease progression, and death in DLBCL patients who had undergone at least 6 cycles of chemotherapy.…”

“…Kong et al [8] retrospectively analyzed 105 patients with DLBCL after 2 cycles of chemotherapy to explore a new prognostic score based on interim PET-CT. Their new prognostic score, which includes age > 60 years, an Ann Arbor stage of III/IV, non-germinal center B-cell (GCB) pathological subtype, and a positive interim PET-CT, has stronger potential for accurate prognostication, stratification in clinical trials, and design of novel strategies for DLBCL patients in the high-risk group. It was predictive of disease progression (HR 8.44; 95% CI 4.19–17.01) and death (HR 8.58; 95% CI 4.22–17.45) [8].…”