Abstract Background Besides International Prognostic Index (IPI) score, baseline prognostic factors of post-transplant lymphoproliferative disorders (PTLD) are poorly identified due to the rarity of the disease. New indexes derived from healthy organ uptake in baseline 18F-FDG PET/CT have been studied in immunocompetent lymphoma patients. The aim of this study is to evaluate the performances of the cerebellum-to-liver uptake ratio (denoted as CLIP) as a prognostic factor for PFS and OS. This retrospective multicenter study is based on patients with PTLD included in the K-VIROGREF cohort. The previously published threshold of 3.24 was used for CLIP in these analyses. Results A total of 97 patients was included with a majority of monomorphic diffuse large B-cell lymphoma subtype (78.3%). Both IPI score (≥ 3) and CLIP (< 3.24) were significant risk factors of PFS with corresponding hazard ratios of 2.0 (1.0–4.0) and 2.4 (1.3–4.5) respectively. For OS, CLIP was not significant and resulted in a hazard ratio of 2.6 ( p = 0.059). Neither IPI score or Total Metabolic Tumor Volume reached significance for OS. Conclusion CLIP is a promising predictor of PFS and perhaps OS in PTLD. Further prospective studies are needed to confirm these results.
Immune checkpoint inhibitors (ICI) are currently the first-line treatment for patients with metastatic melanoma. We investigated the value of positron emission tomography (PET) response criteria to assess the therapeutic response to first-line ICI in this clinical context and explore the potential contribution of total tumor metabolic volume (TMTV) analysis.We conducted a retrospective study in patients treated with first-line ICI for advanced or metastatic melanoma, with 18F-FDG PET/CT performed at baseline and 3 months after starting treatment. Patients' metabolic response was classified according to PERCIST5 and imPERCIST 5 criteria. TMTV was recorded for each examination.Twenty-nine patients were included. The median overall survival (OS) was 51.2 months (IQR 13.6-not reached), and the OS rate at 2 years was 58.6%. Patients classified as responders (complete and partial response) had a 90.9% 2-year OS rate versus 38.9% for non-responders (stable disease and progressive disease) (p = 0.03), for PERCIST5 and imPERCIST 5 criteria. The median change in metabolic volume was 9.8% (IQR -59-+140%). No significant correlation between OS and changes in TMTV was found.The evaluation of response to immunotherapy using metabolic imaging with PERCIST5 and imPERCIST5 was significantly associated with OS in patients with advanced or metastatic melanoma.
Triple-negative breast cancer, an aggressive subtype, represents 15% of invasive breast tumors. This prospective study investigated whether early changes in (18)F-FDG tumor uptake during neoadjuvant chemotherapy (NAC) can predict outcomes.Twenty (M0) patients underwent (18)F-FDG PET/CT at baseline and after the second cycle. NAC was continued irrespective of PET results.At surgery, 6 patients had a pathologic complete response, whereas 14 had residual tumor. Four patients showed early relapse (in the 2 y after surgery). There were 11 metabolic responders and 9 nonresponders using a 42% decrease in maximum standardized uptake value as a cutoff. In nonresponding patients, the risk of residual tumor at surgery was 100% (vs. 45% in responders; P = 0.014), and the risk of early relapse was 44% (vs. 0%; P = 0.024).A less than 42% decrease in (18)F-FDG uptake at 2 cycles means residual tumor at the end of NAC and a high risk of early relapse.
446 Objectives Standard metrics such as Metabolically Active Tumor Volume (MATV), Total Lesion Glycolysis (TLG) and Standardized Uptake Values (SUV) from 18F-FDG PET images are prognostic factors in many solid tumors. The purpose of this study was to quantify functional shape features (SF) in PET images and assess their prognostic value in several cancer types. Methods Patients with Head & neck cancer (HNC) (N=48, with FLT PET images at baseline and during treatment), esophageal cancer (EC) and non-small cell lung cancer (NSCLC) (N=170 and N=100 respectively, with FDG PET baseline images for both) were considered. Primary tumors were delineated with the Fuzzy Locally Adaptive Bayesian algorithm and SF (sphericity, rectangularity…) were calculated. The complementary prognostic value for disease-free (HN) or overall survival (EC and NSCLC) of SF was investigated using multivariate Cox analysis. Models combining features were validated with Leave One Out Cross Validation (LOOCV). Results Some SF had higher prognostic value than most other metrics. Prognostic models with highest hazard ratios (HR) were consistently obtained by combining a SF with another standard metric: sphericity & SUVmean in HNC (HR=6.7), rectangularity & length in EC (HR=4.1) and sphericity & MATV in NSCLC (HR=3.5) (p Conclusions Quantification of tumor functional proliferative and metabolic shape in PET images using SF provides complementary prognostic value with respect to standard volumetric and SUVs parameters in HNC, EC and NSCLC. Research Support This work has received a French government support granted to the CominLabs excellence laboratory and managed by National Research Agency in the “Investing for the future” program under reference ANR-10-LABX-07-01
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