Abstract
The objective of this study is to externally validate the clinical positron emission tomography (PET) model developed in the HOVON-84 trial and to compare the model performance of our clinical PET model using the international prognostic index (IPI). In total, 1195 patients with diffuse large B-cell lymphoma (DLBCL) were included in the study. Data of 887 patients from 6 studies were used as external validation data sets. The primary outcomes were 2-year progression-free survival (PFS) and 2-year time to progression (TTP). The metabolic tumor volume (MTV), maximum distance between the largest lesion and another lesion (Dmaxbulk), and peak standardized uptake value (SUVpeak) were extracted. The predictive values of the IPI and clinical PET model (MTV, Dmaxbulk, SUVpeak, performance status, and age) were tested. Model performance was assessed using the area under the curve (AUC), and diagnostic performance, using the positive predictive value (PPV). The IPI yielded an AUC of 0.62. The clinical PET model yielded a significantly higher AUC of 0.71 (P < .001). Patients with high-risk IPI had a 2-year PFS of 61.4% vs 51.9% for those with high-risk clinical PET, with an increase in PPV from 35.5% to 49.1%, respectively. A total of 66.4% of patients with high-risk IPI were free from progression or relapse vs 55.5% of patients with high-risk clinical PET scores, with an increased PPV from 33.7% to 44.6%, respectively. The clinical PET model remained predictive of outcome in 6 independent first-line DLBCL studies, and had higher model performance than the currently used IPI in all studies.
Original language | English |
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Pages (from-to) | 3055-3064 |
Number of pages | 10 |
Journal | Blood |
Volume | 141 |
Issue number | 25 |
DOIs | |
Publication status | Published - 22 Jun 2023 |
Bibliographical note
Funding Information:This study was financially supported by the Dutch Cancer Society (VU 2018–11648). The PETAL trial was supported by grants from Deutsche Krebshilfe (107592 and 110515). S.F.B. acknowledges the support from the National Institute for Health and Care Research (RP-2-16-07-001). King’s College London and the UCL Comprehensive Cancer Imaging Centre are funded by the CRUK and EPSRC in association with the MRC and the Department of Health and Social Care (England). This work was also supported by core funding from the Wellcome / EPSRC Centre for Medical Engineering at King’s College London (WT203148/Z/16/Z) and the National Institute for Health and Care Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London and the NIHR Clinical Research Facility.
Publisher Copyright:
© 2023 The American Society of Hematology