Cancer Res Treat.  2019 Oct;51(4):1479-1487. 10.4143/crt.2018.649.

Prognostic Value of Baseline and Interim Total Metabolic Tumor Volume and Total Lesion Glycolysis Measured on ¹⁸F-FDG PET-CT in Patients with Follicular Lymphoma

• Liang JH
• Zhang YP
• Xia J
• Ding CY
• Wu W
• Wang L
• Cao L
• Zhu HY
• Fan L
• Li TN
• Li JY
• Xu W

• KMID: 2460596
• DOI: http://doi.org/10.4143/crt.2018.649

Abstract

PURPOSE
The purpose of this study was to investigate the prognostic significance of total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) in patients with follicular lymphoma (FL) at baseline and mid-treatment with ¹â¸F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans.
MATERIALS AND METHODS
The study analyzed data from 48 patients with FL who were treated in Jiangsu Province Hospital and reviewed their baseline PET-CT scans. TMTV and TLG were computed by using the absolute value of 2.0, 2.5, and 3.0 thresholding method, respectively.
RESULTS
Median age was 53 years, 75.0% of patients had stage III to IV disease, 43.8% had a Follicular Lymphoma International Prognostic Index 1 (FLIPI1) score of 3 to 5 and 20.8% had a FLIPI2 score of 3 to 5. Receiver operating characteristic (ROC) curve analysis showed the optimal cut-off values for TMTV3.0 and TLG3.0 were 476.4 (sensitivity, 85.7%; specificity, 78.0%; area under the curve [AUC], 0.760; p=0.003) and 2,676.9 (sensitivity, 71.4%; specificity, 78.0%; AUC, 0.760; p=0.003). On multivariable analysis, TMTV3.0 and TLG3.0 were independent predictors of both progression-free survival (PFS) (hazard ratio [HR], 5.406; 95% confidence interval [CI], 1.326 to 22.040; p=0.019 and HR, 6.502; 95% CI, 1.079 to 39.182; p=0.042) and overall survival (OS) (HR, 4.111; 95% CI, 1.125 to 15.027; p=0.033 and HR, 5.885; 95% CI, 1.014 to 34.148; p=0.049). ROC curve analysis showed the optimal cut-off values for ΔTMTV3.0 and ΔTLG3.0 were 66.3% (sensitivity, 85.7%; specificity, 63.4%; AUC, 0.774; p < 0.001) and 64.5% (sensitivity, 85.7%; specificity, 65.9%; AUC, 0.777; p < 0.001).
CONCLUSION
Baseline TMTV and TLG are strong predictors of PFS and OS in FL. Furthermore, interim TMTV (ΔTMTV > 66.3%) and TLG (ΔTLG > 64.5%) reduction are valuable tools for early treatment response assessment in FL patients.

Keyword

Follicular lymphoma; Prognosis; Total metabolic tumor volume; Total lesion glycolysis; The maximum of standard uptake value

MeSH Terms

Area Under Curve
Disease-Free Survival
Electrons
Glycolysis*
Humans
Lymphoma, Follicular*
Methods
Prognosis
ROC Curve
Sensitivity and Specificity
Tumor Burden*

Figure

• 

  Fig. 1. Progression-free survival (PFS) (A, C) and overall survival (OS) (B, D) according to baseline TMTV3.0 and TLG3.0. TMTV, total metabolic tumor volume; TLG, total lesion glycolysis.

• 

  Fig. 2. Progression-free survival (PFS) (A) and overall survival (OS) (B) according to baseline TMTV3.0 and FLIPI2 score. FLIPI, Follicular Lymphoma International Prognostic Index; TMTV, total metabolic tumor volume; TLG, total lesion glycolysis.

• 

  Fig. 3. Progression-free survival (PFS) (A, C) and overall survival (OS) (B, D) according to ΔTMTV3.0 (66.3%) and ΔTLG3.0 (64.5%). TMTV, total metabolic tumor volume; TLG, total lesion glycolysis.

• 

  Fig. 4. Progression-free survival (PFS) (A) and overall survival (OS) (B) according to ΔTMTV3.0 for the 14 patients with either TMTV3.0 > 476.3 or FLIPI2 3-5. TMTV, total metabolic tumor volume.

Reference

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