Total lesion glycolysis in positron emission tomography is a better predictor of outcome than the International Prognostic Index for patients with diffuse large B cell lymphoma

BACKGROUND: This study was undertaken to evaluate the prognostic value of quantitative metabolic parameters in [18F]2‐fluoro‐2‐deoxyglucose (FDG)‐positron emission tomography (PET) for diffuse large B cell lymphoma (DLBCL). METHODS: A total of 140 DLBCL patients underwent FDG‐PET scans before rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R‐CHOP) chemotherapy. The maximal standardized uptake value (SUVmax) and total lesion glycolysis (TLG) were calculated, with the margin thresholds as 25%, 50%, and 75% of SUVmax of all lesions. Treatment outcomes were compared between groups according to metabolic parameters and the International Prognostic Index (IPI). RESULTS: After a median follow‐up of 28.5 months (range, 5‐81 months), the 2‐year progression‐free survival (PFS) and overall survival (OS) were 83% and 87%, respectively. Among metabolic parameters, TLG at the threshold of 50% (TLG50) was significantly associated with treatment outcomes. High TLG50 values (>415.5) were associated with reduced survivals compared with low TLG50 values (≤415.5) (2‐year PFS of 73% versus 92%, P = .007; and 2‐year OS of 81% versus 93%, P = .031). High IPI score (≥3) significantly reduced OS (2‐year OS of 79% versus 90%, P = .049). Ann Arbor stage III/IV adversely affected PFS (P = .013). However, high IPI score and Ann Arbor stage of III/V did not significantly shorten PFS (P = .200) and OS (P = .921), respectively. High TLG50 values independently predicted survivals by multivariate analysis (hazard ratio = 4.4; 95% confidence interval = 1.5‐13.1; P = .008 for PFS and hazard ratio = 3.1; 95% confidence interval = 1.0‐9.6; P = .049 for OS). CONCLUSIONS: Combined assessment of volume and metabolism (ie, TLG) is predictive of survivals in DLBCL patients who are treated with R‐CHOP. Cancer 2013. © 2012 American Cancer Society. Metabolic tumor burden expressed as total lesion glycolysis in positron emission tomography is predictive of survivals in patients with diffuse large B cell lymphoma (DLBCL) who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R‐CHOP) chemotherapy. Assessment of pretreatment total lesion glycolysis will be helpful to identify risk subgroups and design treatment plans in patients with DLBCL.