Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index
Hongwei Sun,1,2,* Zhan Yu,3,* Ning Ma,3 Jie Zhou,3 Rongrong Tian,3 Ming Zhao,3 Tong Wang1 1Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan City, Shanxi 030001, People’s Republic of China; 2Department of Health Statistics, School of Public Health...
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Dove Medical Press
2019-11-01
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| Series: | Cancer Management and Research |
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| Online Access: | https://www.dovepress.com/risk-stratification-of-diffuse-large-b-cell-lymphoma-with-interim-petc-peer-reviewed-article-CMAR |
| _version_ | 1811306599129546752 |
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| author | Sun H Yu Z Ma N Zhou J Tian R Zhao M Wang T |
| author_facet | Sun H Yu Z Ma N Zhou J Tian R Zhao M Wang T |
| author_sort | Sun H |
| collection | DOAJ |
| description | Hongwei Sun,1,2,* Zhan Yu,3,* Ning Ma,3 Jie Zhou,3 Rongrong Tian,3 Ming Zhao,3 Tong Wang1 1Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan City, Shanxi 030001, People’s Republic of China; 2Department of Health Statistics, School of Public Health And Management, Binzhou Medical University, Yantai City, Shandong 264003, People’s Republic of China; 3Department of PET/CT Center, The Tumor Hospital of Shanxi Province, Taiyuan City, Shanxi 030000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Tong WangDepartment Of Health Statistics, School Of Public Health, Shanxi Medical University, Xinjiannanlu 56, Taiyuan City, Shanxi 030001, People’s Republic of ChinaTel/Fax +86-351-4135397Email tongwang@sxmu.edu.cnMing ZhaoDepartment Of PET/CT Center, The Tumor Hospital Of Shanxi Province, Zhigongxin Street 3, Taiyuan City, Shanxi 030013, People’s Republic of ChinaTel/Fax +86-351-4881611Email zm19701025@163.comPurpose: Prognostic evaluation using interim positron emission tomography/computed tomography (interim PET/CT; I-PET) remains controversial. For any predictor, the prognosis of patients around its cutoff value is most uncertain. If the patients around the cutoff value could be subdivided by another factor, like the international prognostic index (IPI), it may improve the predictive power of I-PET. The combination of I-PET and IPI for risk stratification of patients was explored in this study.Patients and methods: One hundred and eleven diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP therapy were included retrospectively, 59 of whom underwent PET/CT after three or four cycles of treatment (I-PET). Fifty-two patients underwent PET/CT after five or six cycles of treatment (end of treatment; E-PET).Results: When Deauville 5-point scale (5-DS) scores of 4–5 were classified as a positive scan (denoted by DS [score 4]), there was no significant difference in progression-free survival (PFS) between I-PET positive and negative patients (P=0.151). Further, patients with 5-DS score 3 and high IPI were stratified into I-PET positive-, whereas those with 5-DS score 3 and low IPI were classified into I-PET negative scan groups. Under this stratification, there was a significant difference in PFS between I-PET positive and negative patients (P=0.001). The sensitivity, positive predictive value, and negative predictive value for 2-year PFS for the combination score were higher than DS (score 4) alone (66.7% vs 33.3%, 50.0%vs 37.5%, 93.6% vs 88.2%) whereas specificity was almost the same (90.0% vs 88.0%).Conclusion: Subdivision of patients with 5-DS score 3 by IPI improved prognostic prediction accuracy. The IPI adds strength to 5-DS in I-PET to detect patients with good or poor prognosis. Compared with other combinations of I-PET and IPI, dividing the patients around the cutoff value of 5-DS by IPI was easily accepted by clinicians and allowed them to decide on further treatment practically.Keywords: Deauville 5-point scale, interim positron-emission tomography/computed tomography, IPI, cutoff value, subdivision
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| first_indexed | 2024-04-13T08:48:21Z |
| format | Article |
| id | doaj.art-f7469bed0240451eb053d1a4fc3d163c |
| institution | Directory Open Access Journal |
| issn | 1179-1322 |
| language | English |
| last_indexed | 2024-04-13T08:48:21Z |
| publishDate | 2019-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Cancer Management and Research |
| spelling | doaj.art-f7469bed0240451eb053d1a4fc3d163c2022-12-22T02:53:36ZengDove Medical PressCancer Management and Research1179-13222019-11-01Volume 119449945749564Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic IndexSun HYu ZMa NZhou JTian RZhao MWang THongwei Sun,1,2,* Zhan Yu,3,* Ning Ma,3 Jie Zhou,3 Rongrong Tian,3 Ming Zhao,3 Tong Wang1 1Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan City, Shanxi 030001, People’s Republic of China; 2Department of Health Statistics, School of Public Health And Management, Binzhou Medical University, Yantai City, Shandong 264003, People’s Republic of China; 3Department of PET/CT Center, The Tumor Hospital of Shanxi Province, Taiyuan City, Shanxi 030000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Tong WangDepartment Of Health Statistics, School Of Public Health, Shanxi Medical University, Xinjiannanlu 56, Taiyuan City, Shanxi 030001, People’s Republic of ChinaTel/Fax +86-351-4135397Email tongwang@sxmu.edu.cnMing ZhaoDepartment Of PET/CT Center, The Tumor Hospital Of Shanxi Province, Zhigongxin Street 3, Taiyuan City, Shanxi 030013, People’s Republic of ChinaTel/Fax +86-351-4881611Email zm19701025@163.comPurpose: Prognostic evaluation using interim positron emission tomography/computed tomography (interim PET/CT; I-PET) remains controversial. For any predictor, the prognosis of patients around its cutoff value is most uncertain. If the patients around the cutoff value could be subdivided by another factor, like the international prognostic index (IPI), it may improve the predictive power of I-PET. The combination of I-PET and IPI for risk stratification of patients was explored in this study.Patients and methods: One hundred and eleven diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP therapy were included retrospectively, 59 of whom underwent PET/CT after three or four cycles of treatment (I-PET). Fifty-two patients underwent PET/CT after five or six cycles of treatment (end of treatment; E-PET).Results: When Deauville 5-point scale (5-DS) scores of 4–5 were classified as a positive scan (denoted by DS [score 4]), there was no significant difference in progression-free survival (PFS) between I-PET positive and negative patients (P=0.151). Further, patients with 5-DS score 3 and high IPI were stratified into I-PET positive-, whereas those with 5-DS score 3 and low IPI were classified into I-PET negative scan groups. Under this stratification, there was a significant difference in PFS between I-PET positive and negative patients (P=0.001). The sensitivity, positive predictive value, and negative predictive value for 2-year PFS for the combination score were higher than DS (score 4) alone (66.7% vs 33.3%, 50.0%vs 37.5%, 93.6% vs 88.2%) whereas specificity was almost the same (90.0% vs 88.0%).Conclusion: Subdivision of patients with 5-DS score 3 by IPI improved prognostic prediction accuracy. The IPI adds strength to 5-DS in I-PET to detect patients with good or poor prognosis. Compared with other combinations of I-PET and IPI, dividing the patients around the cutoff value of 5-DS by IPI was easily accepted by clinicians and allowed them to decide on further treatment practically.Keywords: Deauville 5-point scale, interim positron-emission tomography/computed tomography, IPI, cutoff value, subdivision https://www.dovepress.com/risk-stratification-of-diffuse-large-b-cell-lymphoma-with-interim-petc-peer-reviewed-article-CMARdeauville 5-point scaleinterim positron-emission tomography/computed tomographyipicutoff valuesubdivision |
| spellingShingle | Sun H Yu Z Ma N Zhou J Tian R Zhao M Wang T Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index Cancer Management and Research deauville 5-point scale interim positron-emission tomography/computed tomography ipi cutoff value subdivision |
| title | Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index |
| title_full | Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index |
| title_fullStr | Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index |
| title_full_unstemmed | Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index |
| title_short | Risk Stratification Of Diffuse Large B-Cell Lymphoma With Interim PET/CT By Combining Deauville Scores And International Prognostic Index |
| title_sort | risk stratification of diffuse large b cell lymphoma with interim pet ct by combining deauville scores and international prognostic index |
| topic | deauville 5-point scale interim positron-emission tomography/computed tomography ipi cutoff value subdivision |
| url | https://www.dovepress.com/risk-stratification-of-diffuse-large-b-cell-lymphoma-with-interim-petc-peer-reviewed-article-CMAR |
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