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. 2022 Apr 14:12:862473.
doi: 10.3389/fonc.2022.862473. eCollection 2022.

Prognostic Value of Heterogeneity Index Derived from Baseline 18F-FDG PET/CT in Mantle Cell Lymphoma

Fei Liu  1   2   3   4   5 , Bingxin Gu  1   2   3   4   5 , Nan Li  1   2   3   4   5 , Herong Pan  1   2   3   4   5 , Wen Chen  1   2   3   4   5 , Ying Qiao  1   2   3   4   5 , Shaoli Song  1   2   3   4   5 , Xiaosheng Liu  1   2   3   4   5
Affiliations

Prognostic Value of Heterogeneity Index Derived from Baseline 18F-FDG PET/CT in Mantle Cell Lymphoma

Fei Liu et al. Front Oncol. .

Abstract

Objectives: Mantle cell lymphoma (MCL) represents a group of highly heterogeneous tumors, leading to a poor prognosis. Early prognosis prediction may guide the choice of therapeutic regimen. Thus, the purpose of this study was to investigate the potential application value of heterogeneity index (HI) in predicting the prognosis of MCL.

Methods: A total of 83 patients with histologically proven MCL who underwent baseline fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) were retrospectively enrolled. The clinicopathologic index and PET/CT metabolic parameters containing maximum and mean standard uptake value (SUVmax and SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and HI were evaluated. Receiver operating characteristic (ROC) curve analyses were performed to determine the optimal cutoff values of the parameters for progression-free survival (PFS) and overall survival (OS). Univariate and multivariate Cox regression were used to assess relationships between risk factors and recurrence. Kaplan-Meier plots were applied for survival analyses.

Results: In univariate analyses, age [HR = 2.51, 95% CI = 1.20-5.24, p = 0.041 for body weight (BW)] and HI-BW (HR = 4.17, 95% CI = 1.00-17.38, p = 0.050) were significantly correlated with PFS. In multivariate analyses, age (HR = 2.61, 95% CI = 1.25-5.47, p = 0.011 for BW) and HI-BW (HR = 4.41, 95% CI = 1.06-18.41, p = 0.042) were independent predictors for PFS, but not for OS. B symptoms (HR = 5.00, 95% CI = 1.16-21.65, p = 0.031 for BW) were an independent prognostic factor for OS, but not for PFS. The other clinicopathologic index and PET/CT metabolic parameters were not related to outcome survival in MCL.

Conclusion: The age and HI derived from baseline PET/CT parameters were significantly correlated with PFS in MCL patients.

Keywords: PET/CT; ROC; heterogeneity index; mantle cell lymphoma; progression-free survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest

Figures

Figure 1
Figure 1
Flow chart of patient selection and exclusion.
Figure 2
Figure 2
Kaplan–Meier curves for PFS according to age, B symptoms, TLG-BW, and HI-BW.
Figure 3
Figure 3
Kaplan–Meier curves for OS according to age, B symptoms, TLG-BW, and HI-BW.
Figure 4
Figure 4
Representative cases of baseline 18F-FDG PET/CT images. A 60-year-old male patient with low HI had extensive lymph node lymphoma invasion and lymphoma infiltration into the oropharynx and spleen (A). The blue and yellow arrows represented the oropharynx, cervical lymph nodes (B), and spleen (C), respectively. The lesions had an SUVmax of 11.09, an SUVmean of 7.10, and a HI of 1.56. We followed up for 39 months and the patient had no recurrence. A 55-year-old male patient with high HI had extensive critical-sized lymph node lymphoma invasion and no lymphoma infiltration into the organs (F). The red and green arrows represented the submaxillary lymph nodes (D) and spleen (E), respectively. The lesions had an SUVmax of 3.35, an SUVmean of 1.13, and a HI of 2.96. The patient developed local recurrence after 29 months of follow-up.
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