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El-Azony A, Basha MAA, Almalki YE, Abdelmaksoud B, Hefzi N, Alnagar AA, Mahdey S, Ali IM, Nasr I, Abdalla AAEHM, Yousef HY, Zaitoun MMA, Elsayed SB, Nada MG, Amin MI, Hassan RM, Ali SA, Dawoud TM, Aly SA, Algazzar YH, Abdelhamed H. The prognostic value of bone marrow retention index and bone marrow-to-liver ratio of baseline 18F-FDG PET/CT in diffuse large B-cell lymphoma. Eur Radiol 2024; 34:2500-2511. [PMID: 37812294 DOI: 10.1007/s00330-023-10150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase 18F-FDG PET/CT in a series of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. PATIENTS AND METHODS This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase 18F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed. RESULTS The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (p < 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (p = 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio [HR] = 4.02, p < 0.001, and HR = 3.23, p < 0.001, respectively) and (HR = 2.83, p = 0.030 and HR = 2.38, p = 0.041, respectively). CONCLUSION Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients. CLINICAL RELEVANCE STATEMENT Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. KEY POINTS • Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients. • High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS). • RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients.
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Affiliation(s)
- Ahmed El-Azony
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Abd Alkhalik Basha
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
| | - Bader Abdelmaksoud
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nabila Hefzi
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A Alnagar
- Department of Medical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sheren Mahdey
- Department of Nuclear Medicine, Nasser Institute, Health Ministry, Cairo, Egypt
| | - Ismail Mohamed Ali
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ibrahim Nasr
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A El-Hamid M Abdalla
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hala Y Yousef
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Saeed Bakry Elsayed
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamad Gamal Nada
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed I Amin
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Rania Mostafa Hassan
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Susan Adil Ali
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Mahmoud Dawoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Heba Abdelhamed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Alabiad MA, Harb OA, Hefzi N, Ahmed RZ, Osman G, Shalaby AM, Alnemr AAA, Saraya YS. Prognostic and clinicopathological significance of TMEFF2, SMOC-2, and SOX17 expression in endometrial carcinoma. Exp Mol Pathol 2021; 122:104670. [PMID: 34339705 DOI: 10.1016/j.yexmp.2021.104670] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 06/21/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022]
Abstract
Background there is a need for novel biomarkers and targeting therapies for predicting Endometrial carcinoma (EC) progression and recurrence. TMEFF2 is a gene that was found to play a role in EMT. SMOC-2 is expressed in embryogenesis and it was identified as a recent stem cell-related gene that has a role in cancer progression. SRY-box 17 (SOX17) is a member of the SRY-related HMG-box (SOX) family of transcription factors. Dysregulation or downregulation of SOX17 expression was found in many cancer tissues. AIM In the present study, we aimed to assess the tissue protein expressions of TMEFF2, SMOC-2, and SOX17 in EC using immunohistochemistry to evaluate their clinicopathological values and prognostic roles in EC patients. PATIENTS AND METHODS This is prospective cohort study included 120 patients with EC. Sections from 120 paraffin blocks were retrieved and stained with TMEFF2, SMOC-2, and SOX17 using immunohistochemistry, the expression of markers in all tissue samples was assessed, analyzed and correlation of pathological parameters with the levels of expression was done. All patients were followed up till death or till the last known alive data for about 50 months (range from 25 to 60). RESULTS TMEFF2, SMOC-2 expression was correlated with the presence of lymph node metastases (p = 0.023), distant metastasis (p = 0.039) recurrence of the tumor after successful therapy, overall survival, and disease-free survival (p < 0.001). SOX17 positive expression was positively correlated with low grade (p = 0.019), absence of lymph node metastasis (p = 0.001), absence of distant metastasis (p = 0.013), low stage (p = 0.03), and its negative expression was positively correlated with recurrence of the tumor after successful therapy, overall survival and disease-free survival (p = 0.001). In conclusion, we demonstrated that both TMEFF2 and SMOC-2 were highly expressed in EC and were associated with a shortened survival rate, dismal outcome, and poor prognosis in EC patients. While SOX17 expression was related to a favorable outcome and its down-regulation was associated with dismal EC patient's survival.
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Affiliation(s)
- Mohamed Ali Alabiad
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Ola A Harb
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nabila Hefzi
- Department of Clinical Oncology& Nuclear Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rham Z Ahmed
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Gamal Osman
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amany Mohamed Shalaby
- Department of Histology and Cell Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Abd-Almohsen Alnemr
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yasser S Saraya
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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