Early 18F-FDG PET for prediction of prognosis in patients with diffuse large B-cell lymphoma:: SUV-based assessment versus visual analysis

The purpose of this study was to assess the prognostic value of early F-18-FDG PET using standardized uptake value (SUV) compared with visual analysis in patients with diffuse large B-cell lymphoma (DLBCL). Methods: Ninety-two patients with newly diagnosed DLBCL underwent F-18-FDG PET prospectively before and after 2 cycles of chemotherapy (at midtherapy). Maximum SUV (SUVmax) and mean SUV (SUVmean) normalized to body weight and body surface area, as well as tumor-to-normal ratios, were computed on the most intense uptake areas. The SUVs, tumor-to-normal ratios, and their changes over time were compared with visual analysis for predicting event-free survival (EFS) and overall survival, using receiver-operating-characteristic (ROC) analysis. Survival curves were estimated with Kaplan-Meier analysis and compared using the log-rank test. Results: With visual analysis, the accuracy of early PET to predict EFS was 65.2%. The 2-y estimate for EFS was 51% (95% confidence interval [CI], 34%-68%) in the PET-positive group compared with 79% (95% CI, 68%-90%) in the PET-negative group (P = 0.009). An optimal cutoff value of 65.7% SUVmax reduction from baseline to midtherapy obtained from ROC analysis yielded an accuracy of 76.1 % to predict EFS. The 2-y estimate for EFS was 21 % (95% CI, 0%-42%) in patients with SUVmax reduction <= 65.7% compared with 79% (95% Cl, 69%-88%) in those with reduction > 65.7% (P < 0.0001). Fourteen patients considered as positive on visual analysis could have been reclassified as good responders. Conclusion: SUV-based assessment of therapeutic response during first-line chemotherapy improves the prognostic value of early F-18-FDG PET compared with visual analysis in DLBCL.