Prognostic superiority of the N ational C omprehensive C ancer N etwork I nternational P rognostic I ndex over pretreatment whole‐body volumetric–metabolic FDG ‐ PET / CT metrics in diffuse large B ‐cell lymphoma

Purpose This study aimed to determine the prognostic value of whole‐body maximum standardized uptake value ( SUV max ), whole‐body metabolic tumor volume ( MTV ), and whole‐body total lesion glycolysis ( TLG ) at pretreatment 18 F‐fluoro‐2‐deoxy‐ d ‐glucose positron emission tomography/computed tomography ( FDG ‐ PET / CT ) in patients with newly diagnosed diffuse large B‐cell lymphoma ( DLBCL ). Materials and Methods Seventy‐three patients with newly diagnosed DLBCL who had undergone FDG ‐ PET / CT before rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone (R‐ CHOP ) immunochemotherapy were retrospectively included. All FDG ‐avid lesions in each patient were segmented using semi‐automated software to calculate whole‐body SUV max , whole‐body MTV , and whole‐body TLG values. Cox regression analyses were used to determine the associations of whole‐body SUV max , whole‐body MTV , whole‐body TLG , and dichotomized National Comprehensive Cancer Network International Prognostic Index ( NCCN ‐ IPI ) risk group (low risk vs. high risk) with progression‐free survival ( PFS ) and overall survival ( OS ). Results On univariate Cox regression analysis, only the NCCN ‐ IPI was a significant predictor of PFS ( P  =   0.024), and only the NCCN ‐ IPI and whole‐body MTV were significant predictors of OS ( P  =   0.039 and P  =   0.043, respectively). In the multivariate Cox proportional hazards model, only the NCCN ‐ IPI remained an independent predictive factor of PFS ( P  =   0.024) and OS ( P  =   0.039). Conclusion Whole‐body SUV max , whole‐body MTV , and whole‐body TLG do not provide any prognostic information in DLBCL beyond that which can already be obtained by the NCCN ‐ IPI . Therefore, the NCCN ‐ IPI remains the most important prognostic tool in this disease.