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. 2014 Sep;48(3):187-95.
doi: 10.1007/s13139-014-0280-6. Epub 2014 May 29.

Prognostic Value of Metabolic Tumor Volume Estimated by (18) F-FDG Positron Emission Tomography/Computed Tomography in Patients with Diffuse Large B-Cell Lymphoma of Stage II or III Disease

Jihyun Kim  1 , Junshik Hong  2 , Seog Gyun Kim  1 , Kyung Hoon Hwang  1 , Minsu Kim  2 , Hee Kyung Ahn  2 , Sun Jin Sym  2 , Jinny Park  2 , Eun Kyung Cho  2 , Dong Bok Shin  2 , Jae Hoon Lee  2
Affiliations

Prognostic Value of Metabolic Tumor Volume Estimated by (18) F-FDG Positron Emission Tomography/Computed Tomography in Patients with Diffuse Large B-Cell Lymphoma of Stage II or III Disease

Jihyun Kim et al. Nucl Med Mol Imaging. 2014 Sep.

Abstract

Purpose: The purpose of this study was to evaluate the prognostic value of metabolic tumor volume (MTV) measured by (18)F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab-containing immunochemotherapy.

Methods: Patients with newly diagnosed DLBCL who underwent pre-treatment torso FDG-PET/CT scan taken within 10 days before treatment were included. MTV was defined as the volume of hypermetabolic tissue with a standardized uptake value (SUV) greater than a threshold value of 2.5 and calculated using volume viewer software. Association of MTV with patient characteristics and survival were compared.

Results: A total of 96 patients were evaluated. During a median follow-up period of 27.8 months, 3-year event-free survival (EFS) and overall survival was 69.5 % and 72.9 %, respectively. The Ann Arbor staging showed a limitation of prognosis because there was no difference of EFS between patients with Ann Arbor stage II and those with stage III. On the contrary, among patients with Ann Arbor stage II or III disease (n = 53), the higher MTV group showed significantly inferior EFS compared with the lower MTV group.

Conclusions: In the current study, we identified the pre-treatment MTV measured by FDG-PET/CT as a potential predictor of survival in patients with DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), at least in Ann Arbor stage II and III disease.

Keywords: Diffuse large cell lymphoma; Metabolic tumor volume; Positron-emission tomography; Prognosis; Tumor burden.

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Figures

Fig. 1
Fig. 1
Measurement of the MTV of tumorous lesions using a standardized uptake value (SUV)-based automated contouring program. a-c A 75-year-old male patient with stage II DLBCL. Volume of interest (VOI) was drawn in the axillar lymph nodes. d-f A 47-year-old male patient with stage III DLBCL. Red-dotted lesions on maximum intensity projection image (d) show segmented MTV
Fig. 2
Fig. 2
A Kaplan-Meier curve for EFS and OS of entire patients
Fig. 3
Fig. 3
Kaplan-Meier curves for EFS of patients stratified according to Ann Arbor staging. a Patients with a limited stage (Ann Arbor I or II) vs an advanced stage (III or IV). b EFS according to each Ann Arbor stage
Fig. 4
Fig. 4
Kaplan-Meier plots in patients with stage II and III disease. The cutoff value of MTVs is 130.7 cm3. a EFS according to MTV in patients with stage II or III disease (n = 53). b EFS according to MTV in patients with Ann Arbor stage II (n = 34). c EFS according to MTV in patients with stage III disease (n = 19)
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