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Toledano MN, Desbordes P, Banjar A, Gardin I, Vera P, Ruminy P, Jardin F, Tilly H, Becker S. Combination of baseline FDG PET/CT total metabolic tumour volume and gene expression profile have a robust predictive value in patients with diffuse large B-cell lymphoma. Eur J Nucl Med Mol Imaging 2018; 45:680-688. [PMID: 29344718 DOI: 10.1007/s00259-017-3907-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 09/24/2017] [Accepted: 12/03/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE This study evaluated the predictive significance of total metabolic tumour volume (TMTV) measured on baseline FDG PET/CT and its value in addition to gene expression profiling using a new method of gene analysis (rapid reverse transcriptase multiplex ligation-dependent probe amplification assay, RT-MLPA) in patients with diffuse large B-cell lymphoma treated with R-CHOP or R-CHOP-like chemotherapies. METHODS The analysis included 114 patients. TMTV was measured using a 41% SUVmax threshold and tumours were classified into GCB or ABC subtypes according to the RT-MLPA assay. RESULTS The median follow-up was 40 months. the 5-year progression-free survival (PFS) was 54% and the 5-year overall survival (OS) was 62%. The optimal TMTV cut-off value was 261 cm3. In 59 patients with a high TMTV the 5-year PFS and OS were 37% and 39%, respectively, in comparison with 72% and 83%, respectively, in 55 patients with a low TMTV (p = 0.0002 for PFS, p < 0.0001 for OS). ABC status was significantly associated with a worse prognosis. TMTV combined with molecular data identified three groups with very different outcomes: (1) patients with a low TMTV whatever their phenotype (n = 55), (2) patients with a high TMTV and GCB phenotype (n = 33), and (3) patients with a high TMTV and ABC phenotype (n = 26). In the three groups, 5-year PFS rates were 72%, 51% and 17% (p < 0.0001), and 5-year OS rates were 83%, 55% and 17% (p < 0.0001), respectively. In multivariate analysis, TMTV, ABC/GCB phenotype and International Prognostic Index were independent predictive factors for both PFS and OS (p < 0.05 for both). CONCLUSIONS This integrated risk model could lead to more accurate selection of patients that would allow better individualization of therapy.
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Affiliation(s)
- Mathieu Nessim Toledano
- Nuclear Medicine Department, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France. .,QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France.
| | - P Desbordes
- QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - A Banjar
- Nuclear Medicine Department, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France.,QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - I Gardin
- Nuclear Medicine Department, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France.,QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - P Vera
- Nuclear Medicine Department, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France.,QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - P Ruminy
- INSERM U918, Centre Henri Becquerel, Rouen, France
| | - F Jardin
- INSERM U918, Centre Henri Becquerel, Rouen, France.,Hematology Department, Centre Henri Becquerel, Rouen, France
| | - H Tilly
- INSERM U918, Centre Henri Becquerel, Rouen, France.,Hematology Department, Centre Henri Becquerel, Rouen, France
| | - S Becker
- Nuclear Medicine Department, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France.,QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
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