title: Prognostic value of tumor necrosis at CT in diffuse large B-cell lymphoma.
abstract: OBJECTIVE
  To determine the prognostic value of tumor necrosis at computed tomography (CT) in newly diagnosed diffuse large B-cell lymphoma (DLBCL).
  
  
  METHODS
  This retrospective study included 51 patients with newly diagnosed DLBCL who had undergone both unenhanced and intravenous contrast-enhanced CT before R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin and prednisolone) chemo-immunotherapy. Presence of tumor necrosis was visually and quantitatively assessed at CT. Associations between tumor necrosis status at CT and the National Comprehensive Cancer Network (NCCN) International Prognostic Index (IPI) factors were assessed. Cox regression analysis was used to determine the prognostic impact of NCCN-IPI scores and tumor necrosis status at CT.
  
  
  RESULTS
  There were no correlations between tumor necrosis status at CT and the NCCN-IPI factors categorized age (ρ=-0.042, P=0.765), categorized lactate dehydrogenase (LDH) ratio (ρ=0.201, P=0.156), extranodal disease in major organs (φ=-0.245, P=0.083), Ann Arbor stage III/IV disease (φ=-0.208, P=0.141), and Eastern Cooperative Oncology Group (ECOG) performance status (φ=0.015, P=0.914). In the multivariate Cox proportional hazards model, only tumor necrosis status at CT was an independent predictive factor of progression-free survival (P=0.003) and overall survival (P=0.004).
  
  
  CONCLUSIONS
  The findings of this study indicate the prognostic potential of tumor necrosis at CT in newly diagnosed DLBCL.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: h.j.a.adams@gmail.com.
authors.forename: Hugo J A
authors.initials: HJA
authors.lastname: Adams
authors.affiliation: Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: John M H
authors.initials: JMH
authors.lastname: de Klerk
authors.affiliation: Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Fijnheer
authors.affiliation: Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Stefan V
authors.initials: SV
authors.lastname: Dubois
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Rutger A J
authors.initials: RAJ
authors.lastname: Nievelstein
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Kwee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000401:mortality / Q000473:pathology*; D010014:Osteolysis; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000401:mortality / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: CT; Diffuse large B-cell lymphoma; Necrosis; Prognosis