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Objectives <p>To evaluate whether baseline splenic ^18F-FDG PET uptake and CT-derived spleen volume predict early progression (≤ 36&#xa0;months) and progression-free survival (PFS) in diffuse large B cell lymphoma (DLBCL), and whether they interact.</p> Materials and methods <p>Retrospective cohort of adults with newly diagnosed DLBCL undergoing baseline ^18F-FDG PET/CT and CT. Splenic PET positivity was defined visually (uptake exceeding hepatic background); spleen volume was measured semi-automatically. Early progression/relapse was analysed as a 36-month milestone endpoint and PFS as time-to-event. Multivariable logistic and Cox models included IPI, sex, treatment, splenic PET, spleen volume, and a PET × volume interaction. A prespecified PFS sensitivity analysis re-included event-free patients censored before 36&#xa0;months.</p> Results <p>124 patients were included (68 men; median age 68&#xa0;years [IQR 57–77]); 45/124 (36.3%) were PET-positive; median spleen volume was 3.13&#xa0;dL (IQR 1.92–5.79). IPI predicted ≤ 36-month progression (OR 1.52; <i>p</i> = 0.021) and PFS (HR 1.44; <i>p</i> = 0.004). Splenic PET positivity predicted ≤ 36-month progression (OR 2.83; <i>p</i> = 0.048) but not PFS (<i>p</i> = 0.103). The PET × volume interaction was significant (OR 0.70; <i>p</i> = 0.021; HR 0.81; <i>p</i> = 0.033). In PET-negative patients, larger spleen volume predicted higher risk (OR 1.42; <i>p</i> = 0.027; HR 1.22; <i>p</i> = 0.042), whereas volume was neutral in PET-positive cases. In the PFS sensitivity analysis (<i>N</i> = 145), the interaction attenuated (HR 0.83; <i>p</i> = 0.057) and the PET-negative volume effect was borderline (HR 1.21; <i>p</i> = 0.053).</p> Conclusion <p>Splenic PET positivity is a dominant risk marker in DLBCL in this cohort. CT-derived spleen volume may add conditional prognostic information in PET-negative patients, but the incremental value of the PET × volume interaction is modest and requires external validation.</p>

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Splenic FDG PET uptake and CT volume as prognostic biomarkers in diffuse large B cell lymphoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月20日

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  • Jacopo D’Argenzio,
  • Nicolò Rampi,
  • Jacopo Pozzi,
  • Valentina Vespro,
  • Matilde Pavan,
  • Elena Casiraghi,
  • Francesca G. Rossi,
  • Angelo Castello,
  • Laura. V. Forzenigo,
  • Massimo Castellani,
  • Massimo Zilocchi,
  • Francesco Passamonti,
  • Gianpaolo Carrafiello

摘要

Objectives

To evaluate whether baseline splenic ^18F-FDG PET uptake and CT-derived spleen volume predict early progression (≤ 36 months) and progression-free survival (PFS) in diffuse large B cell lymphoma (DLBCL), and whether they interact.

Materials and methods

Retrospective cohort of adults with newly diagnosed DLBCL undergoing baseline ^18F-FDG PET/CT and CT. Splenic PET positivity was defined visually (uptake exceeding hepatic background); spleen volume was measured semi-automatically. Early progression/relapse was analysed as a 36-month milestone endpoint and PFS as time-to-event. Multivariable logistic and Cox models included IPI, sex, treatment, splenic PET, spleen volume, and a PET × volume interaction. A prespecified PFS sensitivity analysis re-included event-free patients censored before 36 months.

Results

124 patients were included (68 men; median age 68 years [IQR 57–77]); 45/124 (36.3%) were PET-positive; median spleen volume was 3.13 dL (IQR 1.92–5.79). IPI predicted ≤ 36-month progression (OR 1.52; p = 0.021) and PFS (HR 1.44; p = 0.004). Splenic PET positivity predicted ≤ 36-month progression (OR 2.83; p = 0.048) but not PFS (p = 0.103). The PET × volume interaction was significant (OR 0.70; p = 0.021; HR 0.81; p = 0.033). In PET-negative patients, larger spleen volume predicted higher risk (OR 1.42; p = 0.027; HR 1.22; p = 0.042), whereas volume was neutral in PET-positive cases. In the PFS sensitivity analysis (N = 145), the interaction attenuated (HR 0.83; p = 0.057) and the PET-negative volume effect was borderline (HR 1.21; p = 0.053).

Conclusion

Splenic PET positivity is a dominant risk marker in DLBCL in this cohort. CT-derived spleen volume may add conditional prognostic information in PET-negative patients, but the incremental value of the PET × volume interaction is modest and requires external validation.