Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index
Authors Sun H, Yu Z, Ma N, Zhou J, Tian R, Zhao M, Wang T
Received 8 June 2019
Accepted for publication 24 October 2019
Published 6 November 2019 Volume 2019:11 Pages 9449—9457
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 2
Editor who approved publication: Dr Eileen O'Reilly
Hongwei Sun,1,2,* Zhan Yu,3,* Ning Ma,3 Jie Zhou,3 Rongrong Tian,3 Ming Zhao,3 Tong Wang1
1Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan City, Shanxi 030001, People’s Republic of China; 2Department of Health Statistics, School of Public Health And Management, Binzhou Medical University, Yantai City, Shandong 264003, People’s Republic of China; 3Department of PET/CT Center, The Tumor Hospital of Shanxi Province, Taiyuan City, Shanxi 030000, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Tong Wang
Department Of Health Statistics, School Of Public Health, Shanxi Medical University, Xinjiannanlu 56, Taiyuan City, Shanxi 030001, People’s Republic of China
Department Of PET/CT Center, The Tumor Hospital Of Shanxi Province, Zhigongxin Street 3, Taiyuan City, Shanxi 030013, People’s Republic of China
Purpose: Prognostic evaluation using interim positron emission tomography/computed tomography (interim PET/CT; I-PET) remains controversial. For any predictor, the prognosis of patients around its cutoff value is most uncertain. If the patients around the cutoff value could be subdivided by another factor, like the international prognostic index (IPI), it may improve the predictive power of I-PET. The combination of I-PET and IPI for risk stratification of patients was explored in this study.
Patients and methods: One hundred and eleven diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP therapy were included retrospectively, 59 of whom underwent PET/CT after three or four cycles of treatment (I-PET). Fifty-two patients underwent PET/CT after five or six cycles of treatment (end of treatment; E-PET).
Results: When Deauville 5-point scale (5-DS) scores of 4–5 were classified as a positive scan (denoted by DS [score 4]), there was no significant difference in progression-free survival (PFS) between I-PET positive and negative patients (P=0.151). Further, patients with 5-DS score 3 and high IPI were stratified into I-PET positive-, whereas those with 5-DS score 3 and low IPI were classified into I-PET negative scan groups. Under this stratification, there was a significant difference in PFS between I-PET positive and negative patients (P=0.001). The sensitivity, positive predictive value, and negative predictive value for 2-year PFS for the combination score were higher than DS (score 4) alone (66.7% vs 33.3%, 50.0%vs 37.5%, 93.6% vs 88.2%) whereas specificity was almost the same (90.0% vs 88.0%).
Conclusion: Subdivision of patients with 5-DS score 3 by IPI improved prognostic prediction accuracy. The IPI adds strength to 5-DS in I-PET to detect patients with good or poor prognosis. Compared with other combinations of I-PET and IPI, dividing the patients around the cutoff value of 5-DS by IPI was easily accepted by clinicians and allowed them to decide on further treatment practically.
Keywords: Deauville 5-point scale, interim positron-emission tomography/computed tomography, IPI, cutoff value, subdivision
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