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Purpose <p>To evaluate the prognostic value of interim [<sup>18</sup>F]Fluorodeoxyglucose positron emission tomography/computed tomography ([<sup>18</sup>F]FDG PET/CT) after immunotherapy-based systemic therapies in extranodal natural killer/T-cell lymphoma (ENKTL).</p> Patients and methods <p>We retrospectively recruited 133 newly diagnosed nasal-type ENKTL patients who underwent interim [<sup>18</sup>F]FDG PET/CT scans after 2–4 cycles of immunotherapy-based treatments. Interim PET/CT was interpreted by maximum standardized uptake value (SUV<sub>max</sub>), Deauville 5-point scale (DS), and early treatment response. The prognostic value of overall survival (OS) and progression-free survival (PFS) was assessed with survival curves generated using Kaplan–Meier analysis and compared using the log-rank test. Univariate and multivariate Cox proportional hazards analyses were performed to evaluate the independent effects for survival. Model performance was assessed with a time-dependent area under the curve (time-AUC), concordance index (C-index), and the Akaike information criterion (AIC).</p> Results <p>Patients with high SUV<sub>max</sub> (&gt; 9.2), DS 5, or with stable disease (SD) or relapsed/progressive disease (PD) on interim PET/CT showed significantly unfavorable OS and PFS with the Kaplan–Meier estimate, respectively. The interim PET/CT parameters remained independent predictors for both OS and PFS after univariate and multivariate analysis. We combined interim DS with the prognostic index for natural killer cell lymphoma-Epstein–Barr virus (PINK-E) model to stratify our cohort into 3 risk categories: low-risk (0–2 risk factors), intermediate-risk (3 risk factors), and high-risk (≥ 4 risk factors), which showed significant and superior stratifications of OS and PFS than PINK-E.</p> Conclusion <p>Interim PET/CT after immunotherapy-based systemic treatments showed independent prognostic value for ENKTL. The model combining interim PET/CT with PINK-E might be an effective prognostic tool.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>The prognostic value of interim [</i><sup><i>18</i></sup><i>F]FDG PET/CT in extranodal natural killer/T-cell lymphoma remains uncertain, especially after the introduction of immunotherapy.</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Deauville 5-point scale on interim [</i><sup><i>18</i></sup><i>F]FDG PET/CT after immunotherapy-based systemic therapies was an independent predictor for newly diagnosed extranodal natural killer/T-cell lymphomas.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>Interim [</i><sup><i>18</i></sup><i>F]FDG PET/CT alone or combined with the prognostic index for natural killer cell lymphoma-Epstein–Barr virus (PINK-E) model is an effective and superior prognostic tool for clinical application in the era of immunotherapy.</i></p>

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Prognostic value of interim [18F]FDG PET/CT after immunotherapy-based combinations in extranodal NK/T-cell lymphoma, nasal type

  • 期刊论文

  • 发表日期：

    2025年1月21日

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  • Lei Liu,
  • Shihui Hao,
  • Wanqi Chen,
  • Ming Jing,
  • Shatong Li,
  • Weiguang Zhang,
  • Liping Liang,
  • Wei Fan,
  • Yujing Zhang

摘要

Purpose

To evaluate the prognostic value of interim [18F]Fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) after immunotherapy-based systemic therapies in extranodal natural killer/T-cell lymphoma (ENKTL).

Patients and methods

We retrospectively recruited 133 newly diagnosed nasal-type ENKTL patients who underwent interim [18F]FDG PET/CT scans after 2–4 cycles of immunotherapy-based treatments. Interim PET/CT was interpreted by maximum standardized uptake value (SUVmax), Deauville 5-point scale (DS), and early treatment response. The prognostic value of overall survival (OS) and progression-free survival (PFS) was assessed with survival curves generated using Kaplan–Meier analysis and compared using the log-rank test. Univariate and multivariate Cox proportional hazards analyses were performed to evaluate the independent effects for survival. Model performance was assessed with a time-dependent area under the curve (time-AUC), concordance index (C-index), and the Akaike information criterion (AIC).

Results

Patients with high SUVmax (> 9.2), DS 5, or with stable disease (SD) or relapsed/progressive disease (PD) on interim PET/CT showed significantly unfavorable OS and PFS with the Kaplan–Meier estimate, respectively. The interim PET/CT parameters remained independent predictors for both OS and PFS after univariate and multivariate analysis. We combined interim DS with the prognostic index for natural killer cell lymphoma-Epstein–Barr virus (PINK-E) model to stratify our cohort into 3 risk categories: low-risk (0–2 risk factors), intermediate-risk (3 risk factors), and high-risk (≥ 4 risk factors), which showed significant and superior stratifications of OS and PFS than PINK-E.

Conclusion

Interim PET/CT after immunotherapy-based systemic treatments showed independent prognostic value for ENKTL. The model combining interim PET/CT with PINK-E might be an effective prognostic tool.

Key Points

Question The prognostic value of interim [18F]FDG PET/CT in extranodal natural killer/T-cell lymphoma remains uncertain, especially after the introduction of immunotherapy.

Findings Deauville 5-point scale on interim [18F]FDG PET/CT after immunotherapy-based systemic therapies was an independent predictor for newly diagnosed extranodal natural killer/T-cell lymphomas.

Clinical relevance Interim [18F]FDG PET/CT alone or combined with the prognostic index for natural killer cell lymphoma-Epstein–Barr virus (PINK-E) model is an effective and superior prognostic tool for clinical application in the era of immunotherapy.