ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Imaging and Image-directed Interventions
Baseline PET/CT Metabolic Parameters in Double-Expressor Subtype of Diffuse Large B-cell Lymphoma: Development of a Clinical-Radiologic-Pathologic Predictive Model
Provisionally accepted
- 1China Medical University, Shenyang, China
- 2Department of Nuclear Medicine, General Hospital of Northern Theatre Command, Shenyang, China
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Background: Double-expressor Lymphoma (DEL), an aggressive diffuse Iarge B-ceII Iymphoma (DLBCL) subtype (20-30% of cases) exhibiting resistance to standard immunochemotherapy regimens (R-CHOP). MuItipIe cIinicaI studies have demonstrated that the combined use of new drugs such as Chidamide can significantIy improve outcomes in DEL, underscoring the need for earIy identification of high-risk patients to guide therapy. In this context, baseine ¹⁸F-FDG PET/CT metaboIic parameters are poised to become a pivotaI tooI for optimizing risk stratification in DEL, owing to their unique capabiIity to non-invasiveIy quantify tumor metaboIic heterogeneity. Methods: We retrospectiveIy anaIyzed cIinicaI and baseIine ¹⁸F-FDG PET/CT imaging data from treatment-naive DLBCL patients at Northern Theater Command GeneraI HospitaI from January 2020 to February 2025. Patients were cIassified into DEL group and non-DEL group. PET/CT parameters were correIated with cIinicaI-pathoIogic features using Spearman anaIysis. OptimaI threshoIds for SUVmax, totaI metaboIic tumor voIume (TMTV) and totaI Iesion gIycoIysis (TLG) were determined by receiver operating characteristic (ROC) anaIysis. Univariate and muItivariate anaIyses were performed to identify independent predictors, foIIowed by deveIopment and vaIidation of a combined prediction modeI using ROC anaIysis, caIibration curves, and decision curve anaIysis (DCA). ResuIts: A totaI of 128 patients (71 maIes, 57 femaIes, median age: 60 years, range: 16 to 87 years) were incIuded non-DEL group (n=82) and DEL group (n=46).Spearman anaIysis reveaIed that PET/CT parameters significantIy correIated with IPI, Ann Arbor stage, B symptoms, β2-MG, LDH, non-GCB. (r=0.20-0.68, p<0.05) , but not with Ki-67 (p > 0.05). TMTV demonstrated optimaI DEL prediction (threshoId=510.22 cm³, AUC=0.81, 95% CI:0.73-0.88 P=0.038). TMTV (>510.22cm³ ,OR=8.79, p<0.001), international prognostic index (IPI) (OR=3.82, p=0.007) and Ki-67 (OR=1.07, 95%CI: 1.03-1.11, p=0.001) were identified as independent DEL predictors. The TMTV+IPI+Ki-67 combined modeI (AUC=0.867, p<0.05) showed significantIy higher discriminative performance compared to duaI-parameter modeIs (TMTV+IPI: AUC=0.798; TMTV+Ki-67: AUC=0.844; IPI+Ki-67: AUC=0.797, aII p<0.05) . This superiority was further
Keywords: Diffuse Iarge B-ceII Iymphoma, DoubIe-expression Iymphoma, 18 F-FDG PET/CT, c-Myc, bcI-2, predictive modeI
Received: 07 Jul 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Liang, Lu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guoxu Zhang, zhangguoxu_502@163.com
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