The Correlation Between Pre-treatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Parameters and Clinical Prognostic Factors in Pediatric Hodgkin Lymphoma

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Abstract

Objective:

To compare standardized uptake values (SUV) derived from pre-treatment 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging and clinical prognostic factors in pediatric patients with Hodgkin lymphoma (HL).

Methods:

Pre-treatment FDG PET/CT findings of 28 children with HL were evaluated in this retrospective study. Metabolic tumor volume (MTV), SUV _max normalized by weight (SUVw _eight), lean body mass (SUV _lbm), body surface area (SUV _bsa) and plasma glucose levels of tumors (SUV _glucose) were calculated using pre-treatment FDG PET/CT scan images. These metabolic parameters were correlated with clinical factors [age, sex, number of lymph node groups, presence of splenic involvement, bulky mediastinal disease, Ann Arbor stage, serum white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), serum albumin and hemoglobin levels].

Results:

SUV _bsa, SUV _lbm, SUV _weight, SUV _glucose and MTV were higher in patients with stage III-IV disease, bulky tumor and ≥3 lymph node groups (p<0.05). SUV _bsa and SUV _glucose were higher in patients with splenic involvement (p<0.05). There was no significant correlation between these metabolic parameters and sex, ESR, levels of albumin and WBC (p>0.05). SUV _bsa and SUV _lbm were higher in patients with anemia (p<0.05). Additionally, significant increases were detected in SUV _weight, MTV, and SUV _glucose with increasing age (p=0.005, p=0.027, and p=0.009, respectively). SUV _bsa and SUV _lbm had no significant correlation with age (p>0.05).

Conclusion:

Metabolic parameters derived from pre-treatment FDG PET/CT may have an important role in predicting high-risk disease in patients with HL. Also, SUV _bsa and SUV _lbm may be better markers than SUV _weight in the quantitative evaluation of FDG PET/CT scans in pediatric patients.

Translated abstract

Amaç:

Hodgkin lenfoma (HL) tanısı konmuş çocuk hastalarda klinik prognostik faktörler ile tedavi öncesi ¹⁸F-florodeoksiglukoz (FDG) pozitron emisyon tomografi/bilgisayarlı tomografi (PET/BT) görüntülemeden elde edilen standart tutulum değerlerini (SUV) karşılaştırmaktır.

Yöntem:

Bu retrospektif çalışmada HL tanılı 28 çocuk hastanın FDG PET/BT bulguları değerlendirildi. Metabolik tümör volümü (MTV), kiloya (SUV _kilo), yağsız vücut kitlesine (SUV _lbm), vücut yüzey alanına (SUV _bsa) and plazma glukoz seviyesine (SUV _glukoz) göre normalize edilmiş SUV _maks değerleri tedavi öncesi FDG PET/CT görüntüleri kullanılarak hesaplandı. Bu metabolik parametrelerin klinik faktörler [yaş, cinsiyet, lenf nodu grup sayısı, dalak tutulumu, büyük mediastinal hastalık, Ann Arbor evreleme, serum lökosit sayımı (WBC), eritrosit sedimentasyon hızı (ESH), serum albumin ve hemoglobin seviyesi] ile ilişkisi araştırıldı.

Bulgular:

SUV _bsa, SUV _lbm, SUV _kilo, SUV _glukoz ve MTV evre 3-4 hastalığı, büyük tümörü ve ≥3 lenf nodu grubu olan hastalarda daha yüksekti (p<0,05). SUV _bsa ve SUV _glukoz dalak tutulumu olan hastalarda daha fazlaydı (p<0,05). Bu metabolik parametreler ile cinsiyet, ESR, albumin ve WBC seviyeleri arasında önemli bir ilişki yoktu (p>0,05). SUV _bsa ve SUV _lbm anemisi olan hastalarda daha yüksekti (p<0,05). Ek olarak yaş arttıkça SUV _kilo, MTV ve SUV _glukoz’da önemli artış olduğu saptandı (sırasıyla; p=0,005, p=0,027 ve p=0,009). SUV _bsa ve SUV _lbm ile yaş arasında önemli korelasyon yoktu (p>0,05).

Sonuç:

HL tanılı hastalarda tedavi öncesi FDG PET/BT’den elde edilen metabolik parametreler yüksek riskli hastalığı tahmin etmede önemli bir rol oynayabilir. Ayrıca, pediatrik hastalarda FDG PET/BT’nin kantitatif değerlendirilmesinde SUV _bsa ve SUV _lbm, SUV _kilo’dan daha iyi belirteç olabilir.

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Most cited references 24

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A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease.

D Hasenclever, V Diehl (1998)

Two thirds of patients with advanced Hodgkin's disease are cured with current approaches to treatment. Prediction of the outcome is important to avoid overtreating some patients and to identify others in whom standard treatment is likely to fail. Data were collected from 25 centers and study groups on a total of 5141 patients treated with combination chemotherapy for advanced Hodgkin's disease, with or without radiotherapy. The data included the outcome and 19 demographic and clinical characteristics at diagnosis. The end point was freedom from progression of disease. Complete data were available for 1618 patients; the final Cox model was fitted to these data. Data from an additional 2643 patients were used for partial validation. The prognostic score was defined as the number of adverse prognostic factors present at diagnosis. Seven factors had similar independent prognostic effects: a serum albumin level of less than 4 g per deciliter, a hemoglobin level of less than 10.5 g per deciliter, male sex, an age of 45 years or older, stage IV disease (according to the Ann Arbor classification), leukocytosis (a white-cell count of at least 15,000 per cubic millimeter), and lymphocytopenia (a lymphocyte count of less than 600 per cubic millimeter, a count that was less than 8 percent of the white-cell count, or both). The score predicted the rate of freedom from progression of disease as follows: 0, or no factors (7 percent of the patients), 84 percent; 1 (22 percent of the patients), 77 percent; 2 (29 percent of the patients), 67 percent; 3 (23 percent of the patients), 60 percent; 4 (12 percent of the patients), 51 percent; and 5 or higher (7 percent of the patients), 42 percent. The prognostic score we developed may be useful in designing clinical trials for the treatment of advanced Hodgkin's disease and in making individual therapeutic decisions, but a distinct group of patients at very high risk could not be identified on the basis of routinely documented demographic and clinical characteristics.

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Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project.

Kharma C Foucher, Jean-Paul Sculier, Thierry Berghmans … (2008)

The 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography is an imaging tool for assessing clinical tumor, node, metastasis in non-small cell lung cancer (NSCLC). Primary tumor standardized uptake value (SUV) has been studied as a potential prognostic factor for survival. However, the sample sizes are limited leading to conduct a meta-analysis to improve the precision in estimating its effect. We performed a systematic literature search. For each publication, we extracted an estimate of the hazard ratio (HR) for comparing patients with a low and a high SUV and we aggregated the individual HRs into a combined HR, using a random-effects model. We found 13 eligible studies dedicated to NSCLC. Most of them included patients with stages I to III/IV and used a SUV assessment corrected for body weight. Number of patients ranged from 38 to 315 (total: 1474); 11 studies identified a high SUV as a poor prognostic factor for survival although two studies found no significant correlation between SUV and survival. SUV measurement and SUV threshold for defining high SUV were study dependent, eight studies looked for a so-called best cutoff (maximizing the logrank test statistic) without adjusting the p value for multiplicity. Overall, the combined HR for the 13 reports was 2.27 (95% confidence interval [CI]: 1.70-3.02); excluding the studies proposing a "best" cutoff, it was 2.08 (95% CI: 1.431-3.04). Our meta-analysis suggests that the primary tumor SUV measurement has a prognostic value in NSCLC; these results should be confirmed in a meta-analysis on individual patients' data.

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Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma.

Luca Ceriani, Maurizio Martelli, Pier Luigi Zinzani … (2015)

The International Extranodal Lymphoma Study Group (IELSG) 26 study was designed to evaluate the role of (18)F-fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT) in the management of primary mediastinal (thymic) large B-cell lymphoma (PMBCL). We examined the prognostic impact of functional PET parameters at diagnosis. Metabolic activity defined by the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) was measured on baseline 18FDG PET/CT following a standard protocol in a prospectively enrolled cohort of 103 PMBCL patients. All received combination chemoimmunotherapy with doxorubicin- and rituximab-based regimens; 93 had consolidation radiotherapy. Cutoff values were determined using the receiver-operating characteristic curve. At a median follow-up of 36 months, progression-free survival (PFS) and overall survival (OS) were 87% and 94%, respectively. In univariate analysis, elevated MTV and TLG were significantly associated with worse PFS and OS. Only TLG retained statistical significance for both OS (P = .001) and PFS (P < .001) in multivariate analysis. At 5 years, OS was 100% for patients with low TLG vs 80% for those with high TLG (P = .0001), whereas PFS was 99% vs 64%, respectively (P < .0001). TLG on baseline PET appeared to be a powerful predictor of PMBCL outcomes and warrants further validation as a biomarker. The IELSG 26 study was registered at www.clinicaltrials.gov as #NCT00944567.

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Author and article information

Journal

Journal ID (nlm-ta): Mol Imaging Radionucl Ther

Journal ID (iso-abbrev): Mol Imaging Radionucl Ther

Journal ID (publisher-id): MIRT

Title: Molecular Imaging and Radionuclide Therapy

Publisher: Galenos Publishing

ISSN (Print): 2146-1414

ISSN (Electronic): 2147-1959

Publication date (Print): February 2017

Publication date (Electronic): 1 February 2017

Volume: 26

Issue: 1

Pages: 9-16

Affiliations

[1 ] Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey

[2 ] Ankara Children’s Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology Oncology, Ankara, Turkey

[3 ] Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Department of Pediatric Oncology and Hematology, Ankara, Turkey

[4 ] Gülhane Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey

[5 ] Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Radiology, Ankara, Turkey

Author notes

* Address for Correspondence: Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey GSM: +90 505 914 53 61 E-mail: ebrualkandr@ 123456yahoo.com

Article

Publisher ID: 1948

DOI: 10.4274/mirt.94914

PMC ID: 5350506

PubMed ID: 28291005

SO-VID: c0b808b7-fe9e-49b7-be81-59756acde86b

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Correlation Between Pre-treatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Parameters and Clinical Prognostic Factors in Pediatric Hodgkin Lymphoma

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Abstract

Objective:

Methods:

Results:

Conclusion:

Translated abstract

Related collections

Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 24

A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease.

Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma.

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