Prognostic Value of Massiveness Parameters Measured on Baseline FDG PET in Advanced-Stage Hodgkin Lymphoma

The prognostic value of radiomic quantitative features measured on pretreatment ¹⁸F-FDG PET/CT was investigated in patients with advanced-stage Hodgkin lymphoma (HL).

We conducted a retrospective study of 176 HL patients diagnosed between 2006 and 2017. A dozen of PET/CT-derived features were extracted via Oncometer3D from baseline ¹⁸F-FDG PET/CT images. The receiver operating characteristic (ROC) curves, Kaplan-Meier method, and Cox analyses were used to assess the prognostic factors for Overall Survival (OS) and Progression-Free Survival (PFS) censored at 5 years.

Four different clusters were identified among the 12 PET parameters analyzed: activity, tumor burden, fragmentation-massiveness, and dispersion. On ROC analyses, medEdgeD, a massiveness parameter, had the highest AUC for OS (0.72) and PFS (0.6). Patients with high baseline medEdgeD had a significantly worse PFS (p = 0.04) and OS (p = 0.003) in both Kaplan-Meier and Cox univariate analyses. Furthermore, medEdgeD remained statistically significant in a multivariate analysis (p = 0.008 for OS and p = 0.014 for PFS) including various TEP and clinical parameters used in daily routine. In addition, in sub-group analyses, a significantly worse prognosis was observed for patients with ABVD and with high baseline medEdgeD value (p = 0.0082 for OS and p = 0.001 for PFS). Moreover, in the bulky subgroup, medEdgeD improved prognostic accuracy (p = 0.016).

PET parameters describing massiveness, in particular medEdgeD, are significantly correlated with prognosis in HL patients for OS and PFS, especially when treated with ABVD.