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

Authors

  • Tae Min Kim MD, PhD,

    1. Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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    • The first 2 authors contributed equally to this work.

  • Jin Chul Paeng MD, PhD,

    1. Department of Nuclear Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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    • See editorial on pages 1129–31, this issue.

  • In Kook Chun MD,

    1. Department of Nuclear Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • Bhumsuk Keam MD,

    1. Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • Yoon Kyung Jeon MD, PhD,

    1. Department of Pathology, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • Se-Hoon Lee MD, PhD,

    1. Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • Dong-Wan Kim MD, PhD,

    1. Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • Dong Soo Lee MD, PhD,

    1. Department of Nuclear Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • Chul Woo Kim MD, PhD,

    1. Department of Pathology, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • June-Key Chung MD, PhD,

    1. Department of Nuclear Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • Il Han Kim MD, PhD,

    1. Department of Radiation Oncology, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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  • Dae Seog Heo MD, PhD

    Corresponding author
    1. Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
    • Professor, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

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    • Fax: (011) 82-2-742-6689


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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