Prognostic value of PET/CT characteristics and combined IPI in follicular lymphoma and diffuse large B-cell lymphoma

doi:10.16150/j.1671-2870.2025.02.009

Abstract

Abstract:

Objective The international prognostic index (IPI) has limited ability to distinguish risk levels in patients with follicular lymphoma and diffuse large B-cell lymphoma (FL/DLBCL). This study aims to investigate the diffe-rences in imaging features between FL/DLBCL and DLBCL, and to integrate baseline PET/CT characteristics with clinical parameters to improve the ability of IPI to predict prognosis in FL/DLBCL patients. Methods A total of 65 consecutive patients with pathologically confirmed FL/DLBCL treated at our hospital between January 2015 and January 2022 were collected (follow-up duration: 2.4-113.0 months), and a 1∶1 matched group of patients diagnosed with DLBCL during the same period was selected (follow-up duration: 2.9-91.6 months). PET/CT features and survival differences between the two groups were compared. Cox regression analysis was used to identify independent prognostic factors for progression-free survival (PFS) in FL/DLBCL patients, which were incorporated into a nomogram. The predictive value of the model was evalua-ted using the concordance index (C-index) and receiver operating characteristic (ROC) curves. Results Compared with DLBCL, FL/DLBCL patients had a greater maxium distance between two lesions (Dmax) on PET/CT images (55.07 vs. 33.82, P=0.031) and a greater number of total lesions throughout the body (7 vs. 4, P=0.002). The IPI could only distinguish between low-risk and non-low-risk FL/DLBCL groups (P=0.010), but failed to identify patients at high risk of progression (P=0.743). Integrated analysis of PET/CT imaging features and clinical parameters showed that Dmax (HR=3.151, 95%CI: 1.253-7.922, P=0.015) and IPI (HR=3.285, 95%CI: 1.208-8.932, P=0.020) were independent prognostic factors for PFS in FL/DLBCL patients. On this basis, a nomogram was constructed, with a C-index of 0.701. All three global tests (likelihood ratio test, Wald test, and score test) showed high statistical significance (P<0.001). Conclusion FL/DLBCL exhibits more disseminated characteristics on PET/CT images compared to DLBCL. Additionally, Dmax is a highly promising para-meter for prognostic evaluation in FL/DLBCL, and the nomogram constructed based on Dmax and IPI demonstrates excellent discriminatory ability and predictive accuracy in predicting FL/DLBCL survival outcomes.

Key words: International prognostic index, PET/CT, Diffuse large B-cell lymphoma, Follicular lymphoma, Prognosis

CLC Number:

R814.4

LI Zhuohan, HUANG Xinyun, GUO Rui, YI Hongmei, XU Pengpeng, WU Zhifang, LI Biao. Prognostic value of PET/CT characteristics and combined IPI in follicular lymphoma and diffuse large B-cell lymphoma[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(02): 178-186.

Figures/Tables 7

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Item	FL/DLBCL (N=65)	DLBCL (N=65)	P value
Sex			0.599
Male	33 (50.8%)	30（46.2%）
Female	32 (49.2%)	35（53.8%）
Cell of Origin			0.159
Non-GCBs	31（47.7%）	39(60.0%)
GCBs	14（52.3%）	26(40.0%)
longest diameter of the largest node (cm)			0.303
≤6	47(72.3%)	52(80.0%)
>6	18(27.7%)	13(20.0%)
Double-expressor			0.493
Negative	40(66.7%)	47(72.3%)
Positive	20(33.3%)	18(27.7%)
Bone Marrow Involvement			0.042
Negative	52（80.0%）	60(92.3%)
Positive	13（20.0%）	5(7.7%)
*Age (years)			0.380
≤60	37（56.9%）	32（49.2%）
>60	28（43.1%）	33（50.8%）
*ECOG performance status			0.144
Negative	56（86.2%）	61(93.8%)
Positive	9（13.8%）	4(6.2%)
*Ann Arbor Stage			0.584
1-2	25（38.5%）	22(33.8%)
3-4	40（61.5%）	43(66.2%)
*Number of extra-nodal involvement			0.651
≤2	54（83.1%）	52(80.0%)
>2	11（16.9%）	13(20.0%)
*Serum lactate dehydrogenase levels			0.861
Normal	33（50.8%）	32(49.2%)
> 1×ULN	32（49.2%）	33(50.8%)
*IPI score			0.336
0-1	27（41.6%）	30（46.2%）
2	13（20.0%）	14（21.5%）
3	11（16.9%）	14（21.5%）
4-5	14（21.5%）	7（10.8%）

Item	FL/DLBCL(Median, IQR)	DLBCL(Median, IQR)	P value
SUVmax	21.78(14.87,33.42)	25.68(16.61,37.05)	0.458
MTVmax(mL)	83.13(13.80,378.25)	66.28(25.80,245.75)	0.891
TMTV(mL)	124.39(25.51,649.42)	84.01(40.57,365.78)	0.594
TLGmax	600.87(99.40,2546.89)	699.47(250.10,2420.73)	0.653
TLG	771.22(188.77,4527.02)	881.00(310.94,3735.38)	0.917
Dmax(cm)	55.07(8.37,69.53)	33.82(7.60,54.43)	0.031
Dmaxbulk(cm)	37.48(8.06,52.20)	27.99(7.60,48.09)	0.220
Number of lesions	7(3,21)	4(2,10.5)	0.002

Item	Univariable		Multivariable
Item	HR(95% CI)	P value	HR(95% CI)	P value
Sex	1.871(0.821,4.267)	0.136
Age(years)	1.173(0.533,2.582)	0.693
Cell of origin	1.361(0.611,3.032)	0.450
Double-expressor	0.473(0.158,1.415)	0.181
Extranodal involvement	3.653(1.544,8.641)	0.003
Bone marrow involvement	2.741(1.107,6.784)	0.029
Number of nodal sites	1.874(1.101,3.188)	0.021
Longest diameter of the largest node (cm)	1.655(0.730,3.754)	0.228
Ann Arbor stage	1.502(1.000,2.258)	0.050
B symptoms	1.186(0.463,3.035)	0.723
ECOG performance status	3.868(1.480,10.107)	0.006
IPI*	3.664(1.362,9.860)	0.010	3.285(1.208,8.932)	0.020
Serum lactate dehydrogenase levels	5.001(2.042,12.246)	0.000
β₂-microglobulin	1.826(0.743,4.486)	0.189
Hemoglobin	0.420(0.124,1.428)	0.165
Platelet count	1.817(0.755,4.374)	0.183
SUVmean	1.977(0.828,4.725)	0.125
SUVmax	1.898(0.820,4.393)	0.134
MTVmax	2.644(1.196,5.846)	0.016
TMTV	2.766(1.217,6.286)	0.015
TLGmax	2.949(1.229,7.079)	0.015
TLG	2.851(1.111,5.997)	0.027
Number of lesions	2.411(0.960,6.057)	0.061
Dmax	3.769(1.512,9.396)	0.004	3.151(1.253,7.922)	0.015
Dmaxbulk	2.964(0.881,9.967)	0.079
Spreadbulk	2.370(1.057,5.318)	0.036
Spreadpatient	6.319(0.852,46.834)	0.071