Interim PET/CT based on visual and semiquantitative analysis predicts survival in patients with diffuse large B-cell lymphoma

Purpose The role of interim F-18-FDG PET/CT (iPET/CT) in diffuse large B-cell lymphoma (DLBCL) remains controversial. The purpose of this study was to assess the prognostic value of iPET/CT in patients with newly diagnosed DLBCL according to visual and semiquantitative interpretation methods. Methods A total of 129 newly diagnosed DLBCL patients with baseline PET/CT data were retrospectively screened. The iPET/CT findings were evaluated by the Deauville 5-point scale (DS) and Delta SUVmax. Furthermore, the reduction in SUVmax incorporated with tumor size (Delta SUVmax*Delta SLD) was calculated. The optimal cutoff values of Delta SUVmax and Delta SUVmax*Delta SLD were determined by receiver operating characteristic (ROC) analysis. Kaplan-Meier analysis was applied to test for the influence of prognostic values. Univariate and multivariate analyses were conducted to examine the potential independent impacts of iPET/CT. Results Seventy-seven patients with PET/CT images acquired both at baseline and after four cycles of chemotherapy were finally enrolled. The optimal cutoff values for Delta SUVmax and Delta SUVmax*Delta SLD were 74% and 30%, respectively. After a median follow-up of 23 months, iPET/CT findings were significant predictors of PFS and OS whenever iPET/CT was interpreted by DS, Delta SUVmax, or Delta SUVmax*Delta SLD methods. Delta SUVmax-based methods were more accurate than those based on DS. The IPI, DS, Delta SUVmax, and Delta SUVmax*Delta SLD were predictive in univariate analyses. However, in the multivariate analysis, only IPI and Delta SUVmax remained independent predictors of PFS and OS. Conclusions Interim PET/CT may help to identify DLBCL patients with different prognoses. Delta SUVmax analysis shows the best accuracy and the strongest predictive value among these three methods. Delta SUVmax*Delta SLD may be a promising parameter to interpret iPET/CT images, reflecting both the changes in tumor size and metabolic activity.