Abstract
1602
Objectives Our previous study demonstrated Peking Criteria, a new interpreting method of early interim 18F-FDG PET/CT using liver SUVmax as references, were the better criteria than five-point criteria and %ΔSUVmax criteria in patients with diffuse large B cell lymphoma (DLBCL). In this study, our aim was to further investigate whether Peking criteria could be superior to the other two methods in analyzing interim and end-of-treatment PET.
Methods One hundred twenty six patients with DLBCL were recruited in the study and underwent baseline PET/CT scans. Eighty-eight patients carried out PET/CT after 4 cycles of chemotherapy (PET-4), 91 ones performed end-of-treatment PET/CT (PET-end), and 53 ones were with both interim and posttherapy PET/CT scan. Peking criteria were adopted to analyze the interim and end-of-treatment PET/CT scans, comparing to five-point criteria and %ΔSUVmax criteria. The optimal threshold of Peking Criteria was decided via interobserver agreements and prognostic accuracies. Residue SUVmax higher than the optimal threshold or new 18F-FDG avid lesions indicated the positive lesion in interim or end-of-treatment PET. Prognostic values of PET/CT interpreting with three criteria were compared via the accuracy of survival analysis. Survival curves were obtained using Kaplan-Meier estimates compared using the log-rank test. Uni- and multivariate analyses of outcomes were performed using clinical variables and PET2 scans.
Results The median follow-up was 19 months for 88 patients with PET-4 and 24 months for 91 patients with PET-end. Interobserver agreements were almost perfect (κ value: from 0.824 to 1) when the threshold was set above 1.4 times of SUVmax-liver. In both PET-4 and PET-end, the better specificity, positive predictive value (PPV), and good negative predictive value (NPV) were achieved for progress free survival (PFS) and overall survival (OS) using Peking Criteria, comparing to 5-PS or ΔSUVmax interpretation. The 3-year PFS and OS were 6.67% and 28.57% for PET-4 with positive lesion and 77.07% and 88.13% for negative PET-4, respectively. Also, all of patients with positive lesion in PET-end suffered the progression of disease, while 3-year PFS of negative PET-end was 86.81%. Three-year OS was 44.44% for positive PET-end while 93.03% for the negative. Univariate analysis suggested stage, level of LDH, IPI, and bulky disease were adverse factors for PFS and OS. Cox regression multivariate analysis showed positive residue interpreting with Peking criteria in PET-4 and PET-end was an independent prognostic factor for PFS and OS.
Conclusions This retrospective research demonstrated Peking criteria were better than five-point criteria and %ΔSUVmax criteria in analyzing the interim and end-of-treatment PET imaging for the prognosis of DLBCL patients. Further test of Peking Criteria will be investigated in Hodgkin Disease and other Non-Hodgkin Diseases.
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