Journal of Diagnostics Concepts & Practice >

2025 , Vol. 24 >Issue 02: 178 - 186

DOI: https://doi.org/10.16150/j.1671-2870.2025.02.009

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

  • LI Zhuohan ,
  • HUANG Xinyun ,
  • GUO Rui ,
  • YI Hongmei ,
  • XU Pengpeng ,
  • WU Zhifang ,
  • LI Biao
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  • 1.Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Collaborative Innovation Center for Molecular Imaging, Shanxi Medical University, Taiyuan 030001, China
    2a.Department of Nuclear Medicine, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2b.Department of Nuclear Medicine, Department of Pathology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2c.Department of Nuclear Medicine Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2025-01-06

  Accepted date: 2025-03-24

  Online published: 2025-08-19

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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 differences in imaging features between FL/DLBCL and DLBCL, and to integrate baseline PET/CT characteristics with clinical parameters to improve the prognostic efficiency of the IPI 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 evaluated using the concordance index (C-index) and receiver operating characteristic (ROC) curves. Results Compared with DLBCL, FL/DLBCL patients had a greater maximum distance between two lesions (Dmax) on PET/CT images (55.07 cm vs.33.82 cm, P=0.031) and a greater number of total lesions throughout the body (7 vs. 4, P=0.002). The IPI score could identify FL/DLBCL patients with low risk (IPI score 0-1) (P=0.010), but failed to identify patients with intermediate-low risk, intermediate-high risk or high risk (IPI score 2, 3 and 4-5) (P=0.743). Cox regression analysis confirmed that Dmax > 73.08 cm (HR = 3.151, 95% CI 1.253-7.922, P = 0.015) and IPI score 2-5 (HR = 3.285, 95% CI 1.208-8.932, P=0.020) were independent risk factors for PFS in FL/DLBCL patients. On this basis, a nomogram was constructed to demonstrate that the new model's hazard discrimination capability (P<0.001) significantly outperformed the IPI (P=0.052),with a Cindex of 0.701. The likelihood ratio test, Wald test and score test all demonstrated highly significant statistical significance (χ2 values were 13.27, 12.88, and 15.11, respectively, and P values were 0.001, 0.002, and <0.001, respectively). The area under the ROC curve (AUC) value predicted by the new model for the 2-year PFS rate in FL/DLBCL patients was 0.770, which was higher than the AUC value of 0.702 for IPI; The AUC value of 0.827 for predicting 2-year overall survival (OS) rate was also significantly better than the AUC value of 0.745 for IPI (P<0.05). Conclusion FL/DLBCL exhibits more disseminated characteristics on PET/CT images compared to DLBCL. Additionally, Dmax is a highly promising parameter for prognostic evaluation in FL/DLBCL, and the nomogram constructed based on Dmax >73.08 cm and IPI score of 2 to 5 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

Cite this article

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 . DOI: 10.16150/j.1671-2870.2025.02.009

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