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. 2023 Jun 22;141(25):3055-3064.
doi: 10.1182/blood.2022018558.

Baseline PET radiomics outperforms the IPI risk score for prediction of outcome in diffuse large B-cell lymphoma

J J Eertink  1   2 , G J C Zwezerijnen  2   3 , M W Heymans  4   5 , S Pieplenbosch  2   3 , S E Wiegers  2   3 , U Dührsen  6 , A Hüttmann  6 , L Kurch  7 , C Hanoun  6 , P J Lugtenburg  8 , S F Barrington  9 , N G Mikhaeel  10 , L Ceriani  11   12 , E Zucca  12   13 , S Czibor  14 , T Györke  14 , M E D Chamuleau  1   2 , O S Hoekstra  2   3 , H C W de Vet  4   5 , R Boellaard  2   3 , J M Zijlstra  1   2
Affiliations

Baseline PET radiomics outperforms the IPI risk score for prediction of outcome in diffuse large B-cell lymphoma

J J Eertink et al. Blood. .

Abstract

The objective of this study is to externally validate the clinical positron emission tomography (PET) model developed in the HOVON-84 trial and to compare the model performance of our clinical PET model using the international prognostic index (IPI). In total, 1195 patients with diffuse large B-cell lymphoma (DLBCL) were included in the study. Data of 887 patients from 6 studies were used as external validation data sets. The primary outcomes were 2-year progression-free survival (PFS) and 2-year time to progression (TTP). The metabolic tumor volume (MTV), maximum distance between the largest lesion and another lesion (Dmaxbulk), and peak standardized uptake value (SUVpeak) were extracted. The predictive values of the IPI and clinical PET model (MTV, Dmaxbulk, SUVpeak, performance status, and age) were tested. Model performance was assessed using the area under the curve (AUC), and diagnostic performance, using the positive predictive value (PPV). The IPI yielded an AUC of 0.62. The clinical PET model yielded a significantly higher AUC of 0.71 (P < .001). Patients with high-risk IPI had a 2-year PFS of 61.4% vs 51.9% for those with high-risk clinical PET, with an increase in PPV from 35.5% to 49.1%, respectively. A total of 66.4% of patients with high-risk IPI were free from progression or relapse vs 55.5% of patients with high-risk clinical PET scores, with an increased PPV from 33.7% to 44.6%, respectively. The clinical PET model remained predictive of outcome in 6 independent first-line DLBCL studies, and had higher model performance than the currently used IPI in all studies.

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Conflict of interest statement

Conflict-of-interest disclosure: S.F.B. received departmental funding from Amgen, AstraZeneca, BMS, Novartis, Pfizer and Takeda. M.E.D.C. received financial support for the clinical trials from Celgene, BMS and Gilead. J.M.Z. received financial support for clinical trials from Roche, Gilead, and Takeda. The remaining authors declare no competing financial interests.

A complete list of the members of the PETRA Consortium appears in the supplemental Appendix.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
CONSORT diagram of included patients for external validation. ∗Patients who were not included in the logistic regression model but were included in the Cox regression model.
Figure 2.
Figure 2.
Receiver operating characteristic curves for 2-year PFS for all included patients and separate studies.
Figure 3.
Figure 3.
Survival curves of patients at high and low risk, as identified with IPI and clinical PET models, using 2-year PFS as the outcome.
Figure 4.
Figure 4.
Survival curves of patients at high and low risk as identified with MTV/ECOG, IMPI, and clinical PET models using 2-year progression-free survival as outcome. (A) Risk groups of the MTV/ECOG as defined in the original publication and high-risk groups of the IMPI and clinical PET models are of equal size as the high-risk IPI group. (B) Risk groups for all models are of equal size as the MTV/ECOG groups.
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Comment in

  • A man's best friend is his PET.
    Cheson BD. Cheson BD. Blood. 2023 Jun 22;141(25):3010-3012. doi: 10.1182/blood.2023020325. Blood. 2023. PMID: 37347501 No abstract available.

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