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. 2021 Feb 18;48(10):3198–3220. doi: 10.1007/s00259-021-05233-2

Table 3.

Studies assessing the use of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) in predicting outcomes in diffuse large B cell lymphoma (DLBCL)

Author Year Patient no. Stage Treatment Events (follow-up cut-off) Segmentation threshold MTV/
TLG		 Suggested cut-off Predictive univariate analysis
HR (95% CI)		 Predictive multivariate analysis
HR (95% CI), parameters included in multivariate analysis
I/II III/IV PFS OS PFS OS
Aide [10] 2020 132 NR NR R-CHOP, R-ACVBP

Relapse/death: 102

(2-year)

 SUVmax of liver MTV 111 ml

10.2 (1.4–75.5) (training data set)

NS (Validation dataset)

 NR

NS

aa-IPI LZHGE

 NR
Capobianco [15] 2020 280 26 264 R-CHOP

Relapse: 86

Died: 51

(4-year)

 41% SUVmax MTV 242 ml NR 3.7 (1.9–7.2) NR NR
CNN segmentation MTV 110 ml NR 2.8 (1.6–5.1) NR NR
Decazes [23] 2018 215 51 164 R-CHOP, R-CHOP like, R-ACVBP

Relapse: 92

Died: 74

(5-year)

 41% SUVmax MTV 487 ml 3.10(1.95–4.95) 4.09(2.32–7.21) 2.20 (1.26–3.83) IPI, chemotherapy, TVSR 2.78(1.41–5.48) IPI, chemotherapy, TVSR
Ilyas [27] 2018 147 46 101 R-CHOP

PFS: 65.4%

OS:

73.7%

(5-year)

 PETTRA 2.5 MTV

PFS:396.1 ml

OS: 457.8 ml

 5.9 (2.9–12.2) 5.5 (2.4–12.5) NR NR
HERMES 2.5 MTV

PFS:401.4 ml

OS:

401.4 ml

 5.9 (2.9–12.2 CI)

5.5 (2.4–

12.5)

 NR NR
HERMES PERCIST MTV

PFS:327.4 ml

OS:

669.8 ml

 4.8 (2.4–9.5 CI) 3.7 (1.8–7.8) NR NR
HERMES 41% MTV

PFS:165.7 ml

OS: 189.3 ml

 4.2 (2.2–7.9 CI) for 3.5 (1.8–7.0) NR NR
Senjo [41] 2019 150 (combined training and validation) 66 84 R-CHOP, R-THP-COP, R-CVP

Relapse 21

Died 48

(5-year)

 >4.0 SUV MTV 150 ml NR NR 2.49 (1.57–3.94) 2.75 (1.72–4.38)
Zhang [48] 2019 85 32 53 R-CHOP/R-CHOP-like

Relapse: 23

Died: 6

(3-years)

 MTV 80.74 ml 10.32 (2.42–44.08) NR

NR

Correlated with TLG

 NR
TLG 1036.61 g 10.39 (2.43–44.39) NR 10.42, (2.35–46.30) NR
Toledano [45] 2018 114 26 88 R-CHOP/R-CHOP like

Relapse: 52

Died: 43

(5-year)

 41% SUVmax MTV 261.4 ml 2.91 (1.60–5.29) 4.32 (2.07–8.99)

2.05 (HR 1.02–4.15)

GEP, IPI

2.70 (1.16–6.33)

GEP, IPI
TLG 1325.8 g NS MC 4.82 (2.67–8.71) NR NR
Chang [17] 2017 118 48 70 R-CHOP

Relapse: 55

Died: 49

(5-year)

 ≥2.5 SUV MTV 165.4 ml 3.32 (1.78–6.20) 4.05 (2.07–7.95)

2.31 (1.16–4.60)

IPI

2.38 (1.12–5.04)

Age, IPI
TLG 1204.9 ml 2.57 (1.43–4.61) 2.96 (1.61–5.45) NR NR
Cottereau [22] 2016 81 16 65 R-CHOP, R-ACVBP

Relapse: 34

(5-year)

 41% SUVmax MTV 300 ml 3.06 (1.43–6.54) 3.01 (1.35–6.70) 1.61 (0.70–3.69) 3.0 (1.35–6.70)
TLG 3904 g 2.92 (1.45–5.90) 2.39 (1.16–4.92) NS NS
Song [42] 2016 107* 107 R-CHOP NR ≥2.5 SUV MTV 601.2 ml Sig. Sig.

5.21 (2.54–10.69)

IPI, bulky disease, BMI, IM MTV, CAs

5.33

(2.60–10.90)

IPI, bulky disease, BMI, IM MTV, CAs
IM MTV 260.5 ml Significant Significant NS NS
Zhou [49] 2016 91 34 57 R-CHOP

Relapse: 37

Died: 11

(5-year)

 SUVmean of liver +3 SD MTV

PFS: 70 ml

OS: 78 ml

 88 vs. 37% 98 vs. 60% NS NS
TLG

PFS: 826.5 g

OS: 726 g

 83 vs. 34% 92 vs. 67%

5.21 (2.21–12.28)

MTV, NCCN-IPI, Stage, B symptoms, LDH level Ki-67

9.1 (1.83–45.64)

MTV, NCCN-IPI, Stage, B symptoms, LDH level Ki-67
Mikhaeel [36] 2016 147 46 101 R-CHOP

PFS5: 65.4%

OS5: 73.7%

(5-year)

 41% SUVmax MTV Terties

Upper: 5.81 (2.38–14.14)

Middle: 3.77 (1.49–9.51)

 Sig.

Upper: 3.46 (1.10–10.86)

Middle: 2.73 (0.89–8.40)

 NR
TLG Tertiles

Upper: 4.90 (2.11-

11.38)

Middle: (2.96 1.24

7.10)

 Sig. NR NR
Xie [47] 2016 60 12 48 R-CHOP

Relapse: 17

Died: 3

(40 months)

 SUVmean of liver +2SD MTV Continuous 1.030 (1.017–1.044) NR

1.028 (1.014–1.043)

NCCN-IPI

 NR
TLG Continuous 1.078 (1.042–1.116) NR

1.071 (1.032–1.112)

NCCN-IPI

 NR
Adams [9] 2015 73 11 62 R-CHOP

Relapse: 27

Death: 24

(No defined cut-off)

 40% SUVmax MTV 445 ml NS 2.40 (1.03–5.60) NR

NS

NCCN-IPI
TLG 4897.5 g NS NS NR NR
Kim [30] 2014 96 49 47 R-CHOP

PFS3: 69.5%

OS3: 72.9%

(No defined cut-off)

 ≥2.5 SUV MTV 130.7 ml 11.2 (1.4–88.1) NR

10.4 (1.3–83.4)

IPI >/equal to 3

NS with

IPI as individual parameters

 NR
Gallicchio [25] 2014 52 41 11 R-CHOP like

Relapse: 15

Death: 2

(18 months)

 42% SUVmax MTV 16.1 ml NS NR NR NR
TLG 589.5 g NS NR NR NR
Sasanelli [40] 2014 114 20 94 R-CHOP/R-ACVBP

Relapse: 31

Died: 25

(3-year)

 41% SUVmax MTV 550 ml 77 vs. 60% 87% vs. 60%/59% vs. 78% vs. 84% vs. 93% NS

4.70 (1.82–12.18)

Stage, LDH, Bulky disease

4.11 (1.67–10.16)

aa-IPI, bulky disease
TLG 4576 g NS 64 vs. 85% NR NR
Esfahani [24] 2013 20 8 12 R-CHOP

Relapse: 6

Died: 0

(No defined cut-off)

 50% SUVmax MTV 379.2 ml NS N/A NR n/A
TLG 704.8 g 11.21 (1.29–97) N/A NR N/A
Kim [31] 2013 140 77 63 R-CHOP

Relapse: 21

Died: 16

(2-year)

 25, 50 and 75% SUVmax TLG25 817.8 g 2.8 (1.1–7.1) NS NR NR
TLG50 415.5 g 3.6 (1.3–10.0) 3.3 (1.0–10.0)

3.6 (1.3–10.0)

IPI (2 splits)

3.1 (1.0–9.6)

IPI(2 splits)
TLG75 102.0 g 3.5 (1.3–9.5) NS NR NR
Park [39] 2012 100 55 45 R-CHOP NR Blood Pool threshold TLG NR NS NR NR NR
Song [44] 2012 169 100 69 R-CHOP

PFS: 73.4%

OS: 76.3

(3-year)

 ≥2.5 SUV MTV 220 ml 5.80 (2.79–12.06) 8.10 (3.40–19.31)

5.30 (2.51–11.16)

Stage 3

7.01 (2.90–16.93)

Stage 3

NR not reported; NS not significant; Sig. significant; HR hazard ratio; CI confidence interval; PFS progressive free survival; OS overall survival; R-CHOP rituximab cyclophosphamide, doxorubicin hydrochloride, vincristine (Oncovin) and prednisolone; R-ACVBP Rituximab, Doxorubicin, Cyclophosphamide, Vindesine, Bleomycin, prednisolone; R-THP-COP rituximab, pirarubicin, cyclophosphamide, vincristine and prednisolone; R-CVP rituximab, cyclophosphamide, vincristine, prednisolone; BMI bone marrow involvement; aa-IPI age-adjusted International Prognostic Index; NCCN-IPI National Comprehensive Cancer Network – International Prognostic Index; IM intramedullary; CAs cytogenetic abnormalities; LZHGE Long-Zone High Grey-level Emphasis