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Original Article

Total lesion glycolysis in positron emission tomography is a better predictor of outcome than the International Prognostic Index for patients with diffuse large B cell lymphoma†

  1. Tae Min Kim MD, PhD1,‡,
  2. Jin Chul Paeng MD, PhD2,†,
  3. In Kook Chun MD2,
  4. Bhumsuk Keam MD1,
  5. Yoon Kyung Jeon MD, PhD3,
  6. Se-Hoon Lee MD, PhD1,
  7. Dong-Wan Kim MD, PhD1,
  8. Dong Soo Lee MD, PhD2,
  9. Chul Woo Kim MD, PhD3,
  10. June-Key Chung MD, PhD2,
  11. Il Han Kim MD, PhD4,
  12. Dae Seog Heo MD, PhD1,§,*

Article first published online: 4 DEC 2012

DOI: 10.1002/cncr.27855

Issue

Cancer

Cancer

Volume 119, Issue 6, pages 1195–1202, 15 March 2013

Additional Information

How to Cite

Kim, T. M., Paeng, J. C., Chun, I. K., Keam, B., Jeon, Y. K., Lee, S.-H., Kim, D.-W., Lee, D. S., Kim, C. W., Chung, J.-K., Kim, I. H. and Heo, D. S. (2013), Total lesion glycolysis in positron emission tomography is a better predictor of outcome than the International Prognostic Index for patients with diffuse large B cell lymphoma. Cancer, 119: 1195–1202. doi: 10.1002/cncr.27855

Author Information

  1. 1

    Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

  2. 2

    Department of Nuclear Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

  3. 3

    Department of Pathology, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

  4. 4

    Department of Radiation Oncology, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

  1. †

    See editorial on pages 1129–31, this issue.

  2. ‡

    The first 2 authors contributed equally to this work.

  3. §

    Fax: (011) 82-2-742-6689

*Professor, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

  1. †

    See editorial on pages 1129–31, this issue.

  2. ‡

    The first 2 authors contributed equally to this work.

  3. §

    Fax: (011) 82-2-742-6689

Publication History

  1. Issue published online: 4 MAR 2013
  2. Article first published online: 4 DEC 2012
  3. Manuscript Accepted: 7 JUN 2012
  4. Manuscript Revised: 2 MAY 2012
  5. Manuscript Received: 18 MAR 2012

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Keywords:

  • diffuse large B cell lymphoma;
  • positron emission tomography;
  • total lesion glycolysis;
  • Ann Arbor stage;
  • International Prognostic Index

Abstract

BACKGROUND:

This study was undertaken to evaluate the prognostic value of quantitative metabolic parameters in [18F]2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) for diffuse large B cell lymphoma (DLBCL).

METHODS:

A total of 140 DLBCL patients underwent FDG-PET scans before rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy. The maximal standardized uptake value (SUVmax) and total lesion glycolysis (TLG) were calculated, with the margin thresholds as 25%, 50%, and 75% of SUVmax of all lesions. Treatment outcomes were compared between groups according to metabolic parameters and the International Prognostic Index (IPI).

RESULTS:

After a median follow-up of 28.5 months (range, 5-81 months), the 2-year progression-free survival (PFS) and overall survival (OS) were 83% and 87%, respectively. Among metabolic parameters, TLG at the threshold of 50% (TLG50) was significantly associated with treatment outcomes. High TLG50 values (>415.5) were associated with reduced survivals compared with low TLG50 values (≤415.5) (2-year PFS of 73% versus 92%, P = .007; and 2-year OS of 81% versus 93%, P = .031). High IPI score (≥3) significantly reduced OS (2-year OS of 79% versus 90%, P = .049). Ann Arbor stage III/IV adversely affected PFS (P = .013). However, high IPI score and Ann Arbor stage of III/V did not significantly shorten PFS (P = .200) and OS (P = .921), respectively. High TLG50 values independently predicted survivals by multivariate analysis (hazard ratio = 4.4; 95% confidence interval = 1.5-13.1; P = .008 for PFS and hazard ratio = 3.1; 95% confidence interval = 1.0-9.6; P = .049 for OS).

CONCLUSIONS:

Combined assessment of volume and metabolism (ie, TLG) is predictive of survivals in DLBCL patients who are treated with R-CHOP. Cancer 2013. © 2012 American Cancer Society.

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