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doi: https://doi.org/10.4143/crt.2018.649    [Accepted]
Prognostic Value of Baseline and Interim Total Metabolic Tumour Volume and Total Lesion Glycolysis Measured on 18F-FDG PET/CT in Patients with Follicular Lymphoma
Jin-Hua Liang1, Yun-Ping Zhang1, Jun Xia1, Chong-Yang Ding2, Wei Wu1, Li Wang1, Lei Cao1, Hua-Yuan Zhu1, Lei Fan1, Tian-Nv Li2, Jian-Yong Li1, Wei Xu1
1Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
2Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
Correspondence  Jian-Yong Li ,Email: lijianyonglm@126.com
Wei Xu ,Tel: 86-25-83781120 , Fax: 86-25-83781120 , Email: xuwei10000@hotmail.com
Received: November 26, 2018;  Accepted: March 10, 2019.  Published online: March 12, 2019.
*Jin-Hua Liang and Yun-Ping Zhang contributed equally to this work.
The purpose of this study was to investigate the prognostic significance of total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) in patients with follicular lymphoma (FL) at baseline and mid-treatment with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans.
The study analyzed data from 48 patients with FL who were treated in Jiangsu Province Hospital and reviewed their baseline PET-CT scans. TMTV and TLG were computed by using the absolute value of 2.0, 2.5, and 3.0 thresholding method respectively.
Median age was 53 years, 75.0% of patients had stage III to IV disease, 43.8% had a Follicular Lymphoma International Prognostic Index 1 (FLIPI1) score of 3 to 5 and 20.8% had a FLIPI2 score of 3 to 5. Receiver operating characteristic (ROC) curve analysis showed the optimal cut-off values for TMTV3.0 and TLG3.0 were 476.4 (sensitivity 85.7%; specificity 78.0%; area under the curve [AUC] 0.760; p=0.003) and 2676.9 (sensitivity 71.4%; specificity 78.0%; AUC 0.760; p=0.003). On multivariable analysis, TMTV3.0 and TLG3.0 were independent predictors of both progression-free survival (PFS) (hazard ratio [HR], 5.406; 95% confidence interval [CI], 1.326 to 22.040; p=0.019 and HR, 6.502; 95% CI, 1.079 to 39.182; p=0.042) and overall survival (OS) (HR, 4.111; 95% CI, 1.125 to 15.027; p=0.033 and HR, 5.885; 95% CI, 1.014 to 34.148; p=0.049). ROC curve analysis showed the optimal cut-off values for ΔTMTV3.0 and ΔTLG3.0 were 66.3% (sensitivity, 85.7%; specificity, 63.4%; AUC, 0.774; p<0.001) and 64.5% (sensitivity, 85.7%; specificity, 65.9%; AUC, 0.777; p<0.001).
Baseline TMTV and TLG are strong predictors of PFS and OS in FL. Furthermore, interim TMTV (ΔTMTV > 66.3%) and TLG (ΔTLG > 64.5%) reduction are valuable tools for early treatment response assessment in FL patients.
Key words: Follicular lymphoma, Prognosis, Total metabolic tumor volume, Total lesion glycolysis, The maximum of standard uptake value
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