Tumour necrosis as assessed with F-18-FDG PET is a potential prognostic marker in diffuse large B cell lymphoma independent of MYC rearrangements

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Abstract

OBJECTIVES: MYC gene rearrangements in diffuse large B cell lymphomas (DLBCLs) result in high proliferation rates and are associated with a poor prognosis. Strong proliferation is associated with high metabolic demand and tumour necrosis. The aim of this study was to investigate differences in the presence of necrosis and semiquantitative 18F-FDG PET metrics between DLBCL cases with or without a MYC rearrangement. The prognostic impact of necrosis and semiquantitative 18F-FDG PET parameters was investigated in an explorative survival analysis.

METHODS: Fluorescence in situ hybridisation analysis for MYC rearrangements, visual assesment, semiquantitative analysis of 18F-FDG PET scans and patient survival analysis were performed in 61 DLBCL patients, treated at a single referral hospital between 2008 and 2015.

RESULTS: Of 61 tumours, 21 (34%) had a MYC rearrangement (MYC+). MYC status was neither associated with the presence of necrosis on 18F-FDG PET scans (necrosisPET; p = 1.0) nor associated with the investigated semiquantitative parameters maximum standard uptake value (SUVmax; p = 0.43), single highest SUVmax (p = 0.49), metabolic active tumour volume (MATV; p = 0.68) or total lesion glycolysis (TLG; p = 0.62). A multivariate patient survival analysis of the entire cohort showed necrosisPET as an independent prognostic marker for disease-specific survival (DSS) (HR = 13.9; 95% CI 3.0-65; p = 0.001).

CONCLUSIONS: MYC rearrangements in DLBCL have no influence on the visual parameter necrosisPET or the semi-quantiative parameters SUVmax, MATV and TLG. Irrespective of MYC rearrangements, necrosisPET is an independent, adverse prognostic factor for DSS.

KEY POINTS: • Retrospective analysis indicates that MYC rearrangement is not associated with necrosis on 18 F-FDG PET (necrosis PET ) scans or semiquantitative 18 F-FDG PET parameters. • Necrosis PET is a potential independent adverse prognostic factor for disease-specific survival in patients with DLBCL and is not influenced by the presence of MYC rearrangements.

Original languageEnglish
Pages (from-to)6018-6028
Number of pages11
JournalEuropean Radiology
Volume29
Issue number11
Early online date26-Apr-2019
DOIs
Publication statusPublished - Nov-2019

Keywords

  • Diffuse
  • large B cell
  • lymphoma
  • MYC oncogene
  • Necrosis
  • Fluorodeoxyglucose F18
  • Positron emission tomography
  • POSITRON-EMISSION-TOMOGRAPHY
  • FDG-PET/CT
  • RESPONSE ASSESSMENT
  • QUANTIZATION PARAMETERS
  • CANCER
  • EXPRESSION
  • DIAGNOSIS
  • VOLUME
  • BCL2
  • CLASSIFICATION

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