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Baseline FDG PET/CT SUVmax predicts POD24 and progression-free survival in newly diagnosed follicular lymphoma
Yu-Chieh Lin1, Chin-Chuan Chang2, Tsung-Jang Yeh1
1Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Objective:
Progression of disease within 24 months (POD24) identifies high-risk follicular lymphoma (FL) patients with poor outcomes. The prognostic role of baseline 18 F-FDG PET/CT maximum standardized uptake value (SUVmax) in follicular lymphoma (FL) remains uncertain, especially in Asian populations. We examined the association between baseline SUVmax and POD24, as well as its prognostic relevance for progression-free survival (PFS) in newly diagnosed FL patients.
Methods:
We retrospectively analyzed 119 newly diagnosed FL patients who underwent baseline 18 F-FDG PET/CT at a single institution between 2012 and 2024. Whole-body SUVmax (the highest SUVmax across all lesions) and site-specific SUVmax values were recorded. Clinical variables, including baseline laboratory parameters and histologic grade, were collected. Receiver operating characteristic (ROC) analysis was used to explore an optimal SUVmax cutoff for POD24. Associations with POD24 and PFS were evaluated using Kaplan-Meier analysis and Cox proportional hazards models.
Results:
The median PFS was 54.3 months, and 24.4% of patients experienced POD24. Higher baseline SUVmax was associated with shorter PFS across evaluated sites. ROC analysis showed modest ability to distinguish patients with POD24, with an optimal whole-body SUVmax cutoff of 14.5. Patients with SUVmax > 14.5 had significantly inferior PFS compared with those with SUVmax ≤ 14.5 (median PFS 38.2 months vs. not reached; log-rank p = 0.024) and a higher incidence of POD24 (44.4% vs. 20.8%). In Cox regression, SUVmax as a continuous variable was associated with PFS (HR 1.065, 95% CI 1.008-1.125, p = 0.025), and SUVmax > 14.5 remained an independent predictor of inferior PFS after multivariable adjustment (HR 2.645, 95% CI 1.082-6.467, p = 0.033).
Conclusions:
Baseline whole-body SUVmax is an independent predictor of PFS. A ROC-derived cutoff of 14.5 identified patients with inferior PFS and was associated with a higher incidence of POD24 in newly diagnosed FL. Given its simplicity and availability, SUVmax may serve as a practical adjunctive metabolic biomarker to support baseline risk assessment in routine clinical practice.
