Korean J Intern Med.  2019 Jul;34(4):894-901. 10.3904/kjim.2017.174.

Costs and clinical outcomes of patients with diffuse large B-cell lymphoma in first remission: role of PET/CT surveillance

• Suh KJ
• Kim KH
• Kim R
• Byun JM
• Kim M
• Park JH
• Keam B
• Kim TM
• Kim JS
• Choi IS
• Heo DS

• KMID: 2457320
• DOI: http://doi.org/10.3904/kjim.2017.174

Abstract

BACKGROUND/AIMS
The role of [18F]-f luorodeoxyglucose positron emission tomography-computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) in first remission is unclear.
METHODS
Medical costs within the first 3 years of treatment completion and clinical outcomes of 118 patients with DLBCL in first remission with and without surveillance PET/CT (PET/CT [+] group [n = 76] and PET/CT [−] group [n = 42], respectively) were retrospectively analyzed.
RESULTS
In a propensity matched cohort with adjustment for International Prognostic Index risk and relapse, the PET/CT (+) group was shown to have similar medical costs as the PET/CT (−) group. Relapse-free survival (RFS) and overall survival (OS) were comparable between the two groups (median RFS not reached [NR] for both groups, p = 0.133; median OS NR, p = 0.542). Among 76 patients with surveillance PET/CT, 31 (40.8%) had findings suggestive of recurrence and 16 of these (51.6%) were later confirmed to have recurrent disease. Fifteen patients (48.4%) were confirmed to not have recurrence after follow-up CT or PET/CT evaluation (n = 10) and biopsy (n = 4). None of the patients with negative PET/CT findings had disease recurrence. Sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT for detection of recurrence were 1, 0.75, 0.52, and 1, respectively.
CONCLUSIONS
Surveillance PET/CT resulted in similar clinical outcomes and medical costs compared to no surveillance PET/CT. Approximately half of patients with PET/CT findings of recurrence had no recurrence after follow-up imaging and biopsy, which would not have been carried out if PET/CT had not been performed in the first place.

Keyword

Lymphoma, large B-cell, diffuse; Positron emission tomography computed tomography; Costs and cost analysis; Sensitivity and specificity; Survival

MeSH Terms

B-Lymphocytes*
Biopsy
Cohort Studies
Costs and Cost Analysis
Electrons
Follow-Up Studies
Humans
Lymphoma, B-Cell*
Lymphoma, Large B-Cell, Diffuse
Positron-Emission Tomography and Computed Tomography*
Recurrence
Retrospective Studies
Sensitivity and Specificity