Predictive approaches for post-therapy PET/CT in patients with extranodal natural killer/T-cell lymphoma: a retrospective study

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Abstract

Purpose

The aim of this study was to assess the prognostic capacity of three methods of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT analysis carried out after therapy in patients with extranodal natural killer/T-cell lymphoma (ENKTL). The three methods of PET/CT analysis included the International Harmonization Project (IHP) criteria, the Deauville five-point scale (5-PS), and standardized uptake value (SUV)-based assessment.

Patients and methods

Fifty-nine patients diagnosed with ENKTL were enrolled. Each patient underwent three 18F-FDG PET/CT scans: (i) baseline, (ii) after two to four cycles of chemotherapy (early response assessment), and (iii) at the end of treatment (evaluation of the final response). Post-therapy 18F-FDG PET/CT results were determined on the basis of IHP criteria, 5-PS, and change in the maximum 18F-FDG uptake (ΔSUVmax). IHP criteria, 5-PS, and ΔSUVmax were then examined for their ability to predict progression-free survival (PFS) and overall survival (OS).

Results

Over a median follow-up of 25 months, 5-PS and ΔSUVmax were significant predictors of PFS and OS. After multivariate analysis, 5-PS could predict PFS (P=0.008) and OS (P=0.002) independently. ΔSUVmax was found to be an independent predictor of PFS (P=0.019), but not OS, and had a lower accuracy and positive predictive value than 5-PS.

Conclusion

Post-therapy PET/CT analysis using the 5-PS is more able to predict survival than analysis with IHP or [INCREMENT]SUVmax in ENKTL patients.

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