To explore the prognostic value of the maximum standardized uptake value reduction proportion (ΔSUVmax%) on ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET/CT) imaging, Deauville scores and C-myc gene rearrangement for the prediction of diffuse large B-cell lymphoma (DLBCL) in early chemotherapy.

A total of 83 primary patients with pathologically confirmed DLBCL admitted in Shanxi Provincial Cancer Hospital from September 2010 to December 2016 underwent ¹⁸F-FDG PET/CT 1 week before and after early chemotherapy. The patients underwent post-chemotherapy examinations between 17 to 21 days after one cycle (n=34) or two cycles (n=49). The region of interest (ROI) was drawn and the ΔSUVmax% was calculated. Deauville 5-point scale was used to score the PET/CT imaging in early chemotherapy. Fluorescence in situ hybridization (FISH) was used to detect C-myc gene rearrangement. The follow-up time was from 36 to 111 months. The primary end-point of the study was progression-free survival (PFS). Receiver operating characteristic (ROC) analysis, χ² test, Spearman correlation analysis, Log rank test, and Cox regression analysis were used to analyze the data.

Of 83 DLBCL patients, 19 progressed during the follow-up period. The optimal cut-off value of ΔSUVmax% for predicting tumor progression in early chemotherapy was 62.59%, and the Deauville score was taken as 5. The differences in sensitivity, specificity, and accuracy between the two methods were not statistically significant (P>0.05). The ΔSUVmax% were negatively correlated with C-myc gene rearrangement and the Deauville scores (r_s= -0.889, -0.862, P<0.001). However, the Deauville scores was positively correlated with the C-myc gene rearrangement (r_s=0.781, P<0.001). The median PFS were 59 months and 16 months in ΔSUVmax%≥62.59% (n=57) and ΔSUVmax%<62.59% (n=26), respectively, with significant difference (P<0.001). The median PFS for the Deauville score <5 subgroup (61 cases) and =5 subgroup (22 cases) was 59.0 and 15.0 months, respectively, with statistically significant differences (P<0.001). The median PFS for patients with C-myc rearrangement subgroup (62 cases) and without rearrangement subgroup (21 cases) was 59.0 and 15.0 months, respectively, with statistically significant differences (P<0.001). The median PFS for ΔSUVmax%<62.59% and Deauville score=5 subgroup, ΔSUVmax%<62.59% and C-myc rearrangement subgroup, Deauville score=5 and C-myc rearrangement subgroup were 15.5 months, 15 months and 13.5 months, respectively, with statistically significant differences (P<0.001).

ΔSUVmax%, Deauville score and C-myc gene rearrangement in early chemotherapy are all associated with PFS in DLBCL patients, and the combination of the two has a good predictive value for the prognosis of DLBCL

Lymphoma, large B-cell, diffuse; Positron emission tomography combined with computed tomography; Chemotherapy; C-myc gene; Prognosis