Prognosis estimation under the light of metabolic tumor parameters on initial FDG-PET/CT in patients with primary extranodal lymphoma

Patient no	Age	Gender	Histology	Organ	Presentation site	Rec/Met	Ex	SUV max	SUV mean	MTV	TLG	DFS	OS
1	52	M	DLBC	GIS	Colon	-	-	7.6	4.5	12.5	56.3	44	44
2	75	M	DLBC	GIS	Stomach	-	-	26.9	15.2	1212	18422	40	40
3	45	M	DLBC	GIS	Pancreas	+	+	20	13.1	113	1483	10	18
4	65	M	DLBC	GIS	Jejunum	-	-	10	4.5	7	31.3	67	67
5	52	F	DLBC	GIS	Colon	+	-	8.6	5.8	37.3	216.4	23	143
6	72	F	DLBC	GIS	Stomach	+	+	27.4	18.1	29.9	541.3	8	26
7	69	M	MC	GIS	Stomach	-	+	10	5.2	70.1	367.6	35	35
8	64	F	MALT	GIS	Stomach	-	-	5.1	2.6	57	148.2	63	63
9	52	F	DLBC	GIS	Rectum	+	-	14.8	7.1	13.7	97.7	4	39
10	82	M	DLBC	GIS	Stomach	-	+	15	8.8	90.1	792.8	48	48
11	50	M	DLBC	GIS	Ileum	-	-	6.1	4.4	35.2	154.8	27	27
12	25	M	MALT	GIS	Duodenum	-	-	6.6	4.1	30.8	126.3	122	122
13	47	M	DLBC	GIS	Stomach	-	-	9.9	5.7	96	547.2	111	111
14	65	F	MALT	GIS	Stomach	-	-	10.1	6	135.2	811.2	88	88
15	62	M	MC	GIS	Jejunum	-	-	5.2	3.1	29	89.9	40	40
16	80	F	DLBC	GIS	Stomach	-	-	5.2	2.85	10	28.5	59	59
17	35	M	DLBC	GIS	Stomach	-	-	39.9	21.1	144	3037	17	17
18	87	M	T cell	GIS	Colon	-	-	7.2	4	14.3	57.2	5	5
19	33	M	MALT	GIS	Stomach	-	-	3.2	2	17.9	36.5	34	34
20	57	M	MALT	GIS	Ileum	-	-	7.6	4	18.2	72.8	61	61
21	61	F	DLBC	GIS	Stomach	-	+	20.1	11.15	32.1	358.2	70	70
22	56	M	DLBC	GIS	Stomach	-	+	15.1	8.3	50.5	419.1	123	123
23	49	M	MALT	GIS	Stomach	-	-	3.45	2.8	8.5	23.75	57	57
24	77	M	MALT	GIS	Stomach	-	-	2.9	2.7	7.9	21.25	160	160
25	21	M	Burkitt	GIS	Colon	+	-	10.6	5.2	468	2423	7	32
26	60	M	DLBC	Testis	L;R testicle	+	-	14.8	8.1	98	793.8	21	34
27	53	M	DLBC	Testis	L testicle	-	-	6.5	4	124	496	50	50
28	66	M	DLBC	Testis	L testicle	-	-	7.2	3.8	45	171	101	101
29	68	M	DLBC	Testis	R testicle	+	+	6.9	4.5	143	643.5	16	26
30	67	M	DLBC	Testis	L testicle	+	+	7.8	4.3	112.5	483.7	24	88
31	2	M	Burkitt	Testis	R testicle	-	-	7.5	3.8	33	125.4	42	42
32	21	M	DLBC	Testis	L testicle	+	+	8.6	5.7	128	729.6	9	12
33	57	M	DLBC	Testis	L testicle	+	+	9.5	6.2	77	477.4	35	47
34	56	F	DLBC	CNS	Corpus callosum	+	+	19.2	10.4	43.9	456.4	8	58
35	31	M	DLBC	CNS	Occipital lobe	+	+	9.8	6.5	36.3	236	6	27
36	52	F	MALT	CNS	R orbit	-	-	3.1	2	5.6	11.2	119	119
37	49	M	DLBC	CNS	Frontoparietal lobe;cerebellum	+	+	16.2	8.9	183	1628.7	6	9
38	66	F	DLBC	CNS	Parietooccipital lobe	+	-	9.8	7.2	30.2	217.2	9	30
39	64	M	MC	CNS	R orbit	+	-	3.7	2.9	2.6	7.45	19	38
40	40	F	DLBC	CNS	Cerebellum	+	-	17.5	10.5	10	105	3	7
41	66	M	MALT	CNS	R orbit	-	-	5.8	3.8	1.95	7.4	33	33
42	45	M	DLBC	CNS	Occipital lobe; cerebellum	+	+	22.3	12.4	63.3	782.2	3	3
43	60	M	MALT	CNS	L orbit	-	-	7.1	4.5	2.6	11.8	36	36
44	34	F	DLBC	CNS	Cerebellum; lateral ventricle	+	+	15.6	8.2	21.8	180.1	9	11
45	50	F	DLBC	Bone	Sacrum	-	-	29.1	13.3	218	2896	34	34
46	45	F	DLBC	Bone	Maxilla	+	+	12.2	6.9	29	200.1	18	24
47	85	M	T cell	Bone	Maxilla	+	-	10.5	6.2	14	88	43	95
48	53	F	DLBC	Bone	Mandible	-	-	6.4	3.5	8.2	28.4	64	64
49	69	M	DLBC	Bone	Ethmoid bone	-	-	7.2	5.1	23	117.3	76	76
50	66	M	DLBC	Bone	Distal femur	-	+	8.5	6.4	13	83.2	43	43
51	69	F	DLBC	Bone	Sacrum	-	+	13.6	7.9	190	1501	93	93
52	49	M	DLBC	Bone	Sphenoid bone	-	-	5.7	3.2	61.4	196.5	129	129
53	43	F	DLBC	Bone	T11 vertebrae	-	-	7.2	4.8	8.2	39.4	59	59
54	49	M	DLBC	Bone	Mandible	-	-	13.2	7.5	17.2	129	119	119
55	15	F	DLBC	Bone	Ilium;sacrum	-	-	6.8	4.3	39.2	168.6	114	114
56	27	M	DLBC	Bone	Sphenoid bone	+	-	9.1	5.6	22	123.2	36	123
57	23	M	DLBC	Bone	Iliac bone	-	-	9.7	6.1	43.5	265.4	31	31
58	23	M	T cell	HN	Nose	+	+	9.1	5.7	38.2	217.7	13	35
59	42	M	DLBC	HN	Nasopharynx	-	-	7.1	3.9	9	35.1	100	100
60	39	F	DLBC	HN	Velum (palatum molle)	-	-	18.6	10.2	20	203	41	41
61	41	M	Burkitt	HN	Gum	+	+	16.6	8.5	18.6	158.1	16	23
62	54	M	MC	HN	Nasopharynx	-	-	7.9	4.4	5	22	127	127
63	75	M	T cell	HN	Parotid gland	+	+	10.2	6.6	27.6	182.2	13	29
64	53	M	T cell	HN	Nose	-	-	11.2	6.4	8.3	53.1	133	133
65	41	F	Burkitt	Breast	R breast	+	-	42	14.5	108	1555	10	63
66	36	M	MALT	Lung	L lung	-	-	3.8	2.3	7.75	17.7	50	50
67	48	M	MALT	Lung	R lung	-	-	6.4	3.95	109.9	431.8	53	53

CNS = Central Nervous System; DLBC = Diffuse Large B Cell; GIS = Gastrointestinal System; HN = Head and Neck; F = Female; M = Male; MALT = Mucosa-associated Lymphoid Tissue; MC = Mantle Cell; L = Left; R = Right; Rec = Recurrence

Kaplan-Meier curve of SUVmean with a cut-off value of 5.15.

Table 2

Univariate Cox regression analysis.

Factors	Significance (p value)	Hazard Ratio	95% CI for Hazard Ratio
Factors	Significance (p value)	Hazard Ratio	Lower	Upper
Sex*	0.363	0.495	0.108	2.254
Age	0.080	0.971	0.939	1,004
DLBC**	0.265		Reference
Mantle Cell	0.672	0.550	0.034	8.783
T Cell	0.038	10.535	1.135	97.758
Burkitt	0.720	1.535	0.147	15.982
MALT	0.962	0.000	0.000	-
GIS***	0.000		Reference
Testis	0.163	3.503	0,602	20.378
CNS	0.000	216.611	20.786	2257.305
Bone	0.898	1.135	0.165	7.818
Head and
neck	0.916	0.879	0.080	9.709
Lungs	0.999	3.422	0.000	-
SUVmax	0.032	0.680	0.478	0.968
SUVmean	0.000	3.630	1.791	7.355
MTV	0.001	1,035	1.015	1.056
TLG	0.011	0.996	0.993	0.999

Reference groups: *male sex, **DLBC,***GIS

Table 3

Multivariate Cox regression analysis.

Factors	Significance (p value)	Hazard Ratio	95% CI for Hazard Ratio
Factors	Significance (p value)	Hazard Ratio	Lower	Upper
SUVmean	0.000	1.418	1.226	1.640
MTV	0.000	1.020	1.009	1.031
TLG	0.002	0.998	0.996	0.999

Table 4

Cut-off values, sensitivity, specificity of SUVmean, MTV and TLG.

Factors	Cut-off Value	Sensitivity (%)	Specificity (%)
SUVmean	5.15	88	64
MTV (cm³)	18.4	84	45
TLG	175.55	76	64

There was a mass in antrum of stomach on transaxial CT **(A)**, PET **(B)**, fusion **(C)** and MIP images **(D)** (arrows) of a 60-year old female patient with primary gastric lymphoma of DLBC type. She had metabolic tumor parameters of SUVmax: 11, SUVmean: 5, MTV:34 cm³, TLG:150. Her outcome was excellent with a DFS and OS of 111 months.

61-year old female patient was diagnosed with primary CNS lymphoma of DLBC type. There was a mass in right periventricular region adjacent to right thalamus on transaxial PET **(A)**, CT **(B)** and fusion **(C)** images (arrows). She was in serious risk because of her high metabolic tumor parameters (SUVmax: 35, SUVmean: 25, MTV: 425 cm³, TLG: 2543) and died of the disease 11 months after the diagnosis.

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DOI: https://doi.org/10.1515/raon-2016-0045 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 360 - 369

Submitted on: Apr 20, 2016

Accepted on: Jun 16, 2016

Published online: Sep 8, 2016

Published in print: Dec 1, 2016

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

18-fluorodeoxyglucose positron emission tomography/computed tomography,

metabolic tumor parameters,

primary extranodal lymphoma

Related subjects:

Medicine,

Clinical medicine,

Radiology

© 2016 Kursat Okuyucu, Sukru Ozaydın, Engin Alagoz, Gokhan Ozgur, Semra Ince, Fahrettin Guven Oysul, Ozlem Ozmen, Murat Tuncel, Mustafa Ozturk, Nuri Arslan, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Volume 50 (2016): Issue 4 (December 2016)