Basal (18)F-FDG PET/CT in follicular lymphoma: A comparison of metabolic and clinical variables in the prognostic assessment.
OBJECTIVE
To analyze the relationship of clinical variables related to prognosis and tumor burden, with metabolic variables obtained in the staging (18)F-FDG PET/CT, and their value in the prognosis in follicular lymphoma (FL).


METHODS
82 patients with FL, a (18)F-FDG PET/CT at diagnosis and a follow-up for a minimum of 12 months, were retrospectively enrolled in the present study. Clinical variables (Tumor grade, Follicular Lymphoma International Prognostic Index (FLIPI) and Tumor burden) were evaluated. Metabolic variables such as SUVmax in the highest hypermetabolic lesion, extralymphatic locations, number of involved lymph node locations, bone marrow (BM) involvement, PET stage and diameter of the biggest hypermetabolic lesion, were analyzed in order to establish a PET score and classify the studies in low, intermediate and high metabolic risk. Clinical and metabolic variables (included metabolic risk) were compared. The relation among all variables and disease-free survival (DFS) was studied.


RESULTS
The 28% of patients had a high-grade tumor. The 30.5% had FLIPI risk low, 29.3% intermediate y 40.2% high. The 42.7% presented a high tumor burden. The PET/CT was positive in 94% of patients. The tumor grade did not show significant relation with metabolic variable. FLIPI risk and tumor burden showed statistical relations with the SUV max and the PET score (p<0.008 and p=0.003 respectively). With respect to DFS, significant differences were detected for the PET stage and FLIPI risk (p=0.015 and p=0.047 respectively). FLIPI risk was the only significant predictor in Cox regression analysis, with a Hazard Ratio of 5.13 between high risk and low risk.


CONCLUSIONS
The present research highlights the significant relation between metabolic variables obtained with FDG PET/CT and clinical variables although their goal as an independent factor of prognosis was not demonstrated in the present work.
Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain. Electronic address: gjimenez91@yahoo.com.
G A
GA
Jiménez Londoño
Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain.
A M
AM
García Vicente
Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain.
V M
VM
Poblete García
Department of Mathematics, University of Castilla La Mancha, Ciudad Real, Spain.
M
M
Amo-Salas
Department of Hematology, Hospital General Universitario de Ciudad Real, Spain.
C
C
Calle Primo
Department of Hematology, Complejo Hospitalario Universitario de Albacete, Spain.
Á
Á
Ibañez García
Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain.
B
B
Martínez Sanchís
Department of Mathematics, University of Castilla La Mancha, Ciudad Real, Spain.
J F
JF
López-Fidalgo
Department of Hematology, Hospital Ntra. Sra. del Prado, Talavera de la Reina, Toledo, Spain.
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Solano Ramos
Department of Hematology, Complejo Hospitalario Universitario de Albacete, Spain.
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A
Martínez Hellín
Department of Hematology, Hospital Universitario de Guadalajara, Spain.
M
M
Díaz Morfa
Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain.
Á
Á
Soriano Castrejón
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008137:Longitudinal Studies; D008224:Lymphoma, Follicular / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
(18)F-FDG PET/CT; (18)F-FDG PET/TC; Estadificación; Follicular lymphoma; Linfoma folicular; Metabolic risk; PET prognostic score; PET-TC Score; Prognosis; Pronóstico; Riesgo metabólico; Staging