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New Approaches in Characterization of Lesions Dissemination in DLBCL Patients on Baseline PET/CT

Department of Nuclear Medicine, Cochin Hospital, AP-HP, University of Paris, 75014 Paris, France
LITO Laboratory, U1288, Institut Curie, Université PSL, Inserm, Université Paris Saclay, 91400 Orsay, France
LYSA Imaging, Henri Mondor University Hospital, AP-HP, University Paris East, 94000 Créteil, France
The Lymphoma Academic Research Organisation, Statistic, Centre Hospitalier Lyon Sud, 69000 Pierre-Benite, France
Department of Nuclear Medicine, Saint-Louis Hospital, AP-HP, 75010 Paris, France
Department of Hematology, University Hospital of Dijon, 21231 Dijon, France
Department of Hematology, Saint-Louis Hospital, AP-HP, Hemato-Oncology, DMU DHI, 1 Av. Claude Vellefaux, 75010 Paris, France
Research Unit NF-kappaB, Différenciation et Cancer, Université de Paris, 12 Rue de l’École de Médecine, 75006 Paris, France
Author to whom correspondence should be addressed.
Academic Editors: Nicola Stefano Fracchiolla and Francesco Onida
Cancers 2021, 13(16), 3998;
Received: 30 June 2021 / Revised: 1 August 2021 / Accepted: 5 August 2021 / Published: 8 August 2021
(This article belongs to the Special Issue Hematologic Malignancy)
Recently, a new PET parameter expressing lymphoma dissemination has been proposed to identify high-risk DLBCL patients: the distance between the two furthest lesions, standardized by body surface area (SDmax). This study aimed to determine the best way to measure the distance between lesions, by comparing different methods of distance measurements. We obtained similar results in terms of prediction of outcome between the different methods further validating the relevance of the dissemination features. We highlighted the possibility to calculate it directly from lymphoma voxels instead of lesion centroids, and thus applied it to a metabolic tumor volume (MTV) determined by deep learning algorithms. This could allow the use in clinical practice of this parameter, characterizing tumor spread, in combination with the tumor burden, for patient risk stratification.
Dissemination, expressed recently by the largest Euclidian distance between lymphoma sites (SDmax), appeared a promising risk factor in DLBCL patients. We investigated alternative distance metrics to characterize the robustness of the dissemination information. In 290 patients from the REMARC trial (NCT01122472), the Euclidean (Euc), Manhattan (Man), and Tchebychev (Tch) distances between the furthest lesions, firstly based on the centroid of each lesion and then directly from the two most distant tumor voxels and the Travelling Salesman Problem distance (TSP) were calculated. For PFS, the areas under the ROC curves were between 0.63 and 0.64, and between 0.62 and 0.65 for OS. Patients with high SDmax whatever the method of calculation or high SD_TSP had a significantly poorer outcome than patients with low SDmax or SD_TSP (p < 0.001 for both PFS and OS), with significance maintained in Ann Arbor advanced-stage patients. In multivariate analysis with total metabolic tumor volume and ECOG, each distance feature had an independent prognostic value for PFS. For OS, only SDmax_Tch, SDmax_Euc _Vox, and SDmax_Man _Vox reached significance. The spread of DLBCL lesions measured by the largest distance between lymphoma sites is a strong independent prognostic factor and could be measured directly from tumor voxels, allowing its development in the area of the deep learning segmentation methods. View Full-Text
Keywords: dissemination metrics; FDG-PET/CT; DLBCL; SDMax dissemination metrics; FDG-PET/CT; DLBCL; SDMax
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MDPI and ACS Style

Cottereau, A.-S.; Meignan, M.; Nioche, C.; Clerc, J.; Chartier, L.; Vercellino, L.; Casasnovas, O.; Thieblemont, C.; Buvat, I. New Approaches in Characterization of Lesions Dissemination in DLBCL Patients on Baseline PET/CT. Cancers 2021, 13, 3998.

AMA Style

Cottereau A-S, Meignan M, Nioche C, Clerc J, Chartier L, Vercellino L, Casasnovas O, Thieblemont C, Buvat I. New Approaches in Characterization of Lesions Dissemination in DLBCL Patients on Baseline PET/CT. Cancers. 2021; 13(16):3998.

Chicago/Turabian Style

Cottereau, Anne-Ségolène, Michel Meignan, Christophe Nioche, Jérôme Clerc, Loic Chartier, Laetitia Vercellino, Olivier Casasnovas, Catherine Thieblemont, and Irène Buvat. 2021. "New Approaches in Characterization of Lesions Dissemination in DLBCL Patients on Baseline PET/CT" Cancers 13, no. 16: 3998.

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