Predictive value of interim PET/CT visual interpretation in the prognosis of patients with aggressive non-Hodgkin’s lymphoma

Figures & data

Table 1 Patient baseline characteristics

Eligible studies	Year	Patient number	Research design	Average age (years)	Pathology	Chemotherapy regimen	Number of chemotherapy cycles before interim PET	Visual method criteria	Ann arbor staging (i, ii/iii, iv)
Zinzani et al^Citation18	2011	91	Prospect	54	DLBCL, PMLBCL	R-CHOP	2	IHP	30/61
Yoo et al^Citation20	2011	155	Review	N/A	DLBCL	R-CHOP	2–4	No standard interpretation#	68/87
Yang et al^Citation19	2011	159	Review	61	DLBCL	R-CHOP	3–4	IHP	94/67
Spaepen et al^Citation21	2002	70	Prospect	50	DLBCL, ALCL, MCL, BL, PTCL	CHOP	3–4	No standard interpretation#	22/49
Safar et al^Citation22	2012	112	Prospect	59	DLBCL	R-CHOP, R-ACVBP	2	No standard interpretation#	21/91
Nols et al^Citation23	2014	73	Review	60	DLBCL	R-CHOP, R-ACVBP	3–4	Deauville	23/50
Haioun et al^Citation24	2005	90	Prospect	53	DLBCL, PTCL	CHOP/ACVBP/ACE ± R	2	No standard interpretation#	8/82
Cashen et al^Citation25	2011	50	Prospect	58	DLBCL	R-CHOP	2–3	IHP	0/50
Pregno et al^Citation7	2012	88	Prospect	55	DLBCL	R-CHOP	2–4	Deauville	29/59
Itti et al^Citation26	2013	114	Review	56	DLBCL	R-CHOP, R-ACVBP	2	IHP	20/94
Mamot et al^Citation27	2015	125	Prospect	59	DLBCL	R-CHOP	2	Deauville	64/74

Note:

# Mainly based on non-physiological-FDG tissue uptake as an interpretation reference.

Abbreviations: DLBCL, diffuse large B-cell lymphoma; PMLBCL, primary mediastinal large B-cell lymphoma; IHP, International Harmonization Project; ALCL, anaplastic large cell lymphoma; CHOP, cyclophosphamide, hydroxydaunomycin, oncovin (vincristine), prednisone; MCL, mantle cell lymphoma; BL, Burkitt’s lymphoma; PTCL, peripheral T-cell lymphoma; R, rituximab; ACVBP, adriamycin (doxorubicin), cyclophosphamide, vindesine, bleomycin, prednisone; ACE, adriamycin, cyclophosphamide, etoposide; FDG, fludeoxyglucose; PET, positron emission tomography; N/A, not available.

Table 2 Methodological quality evaluation (NOS)

Eligible studies	Selection				Comparability	Outcome			Score
	Representativeness of exposed queues	Selection of non-exposed queues	Determination of exposure	No subject had any outcome event prior to the study		Assessment of outcome events	Follow-up is sufficient?	Completeness of follow-up
Zinzani et al^Citation18	*	*	*	*	**	*	*	*	9
Yoo et al^Citation20	*	*	*	*	*	*	*	*	8
Yang et al^Citation19	*	*	*	*	*	*	*	*	8
Spaepen et al^Citation21	*	*	*	*	*	*	*	*	8
Safar et al^Citation22	*	*	*	*	**	*	*	*	9
Nols et al^Citation23	*	*	*	*	*	*	*	*	8
Haioun et al^Citation24	*	*	*	*	**	*	*	–	8
Cashen et al^Citation25	*	*	*	*	*	*	–	*	7
Pregno et al^Citation7	*	*	*	*	*	*	–	*	7
Itti et al^Citation26	*	*	*	*	*	*	–	*	7
Mamot et al^Citation27	*	*	*	*	*	*	*	*	8

Notes: The full score of comparability is 2. The score of the remaining items is 1 point.

** indicates 2 point;

* Indicates 1 point; – indicates no points.

Abbreviation: NOS, Newcastle-Ottawa quality assessment scale.

Figure 1 Meta-analysis of PFS for interim PET/CT visual evaluation of aggressive non-Hodgkin’s lymphoma (subgroups = interpretation criteria).

Note: ‘–’ indicates not available.
Abbreviations: IHP, International Harmonization Project; PFS, progression-free survival; PET/CT, positron emission tomography/computed tomography; HR, hazard ratio; CI, confidence interval; TE, estimate of treatment effect; seTE, standard error of treatment estimate.

Figure 2 Meta-analysis of PFS for interim PET/CT visual evaluation of aggressive non-Hodgkin’s lymphoma (subgroups = number of chemotherapy cycles before PET/CT).

Note: ‘–’ indicates not available.
Abbreviations: PFS, progression-free survival; PET/CT, positron emission tomography/computed tomography; HR, hazard ratio; CI, confidence interval; TE, estimate of treatment effect; seTE, standard error of treatment estimate.

Figure 3 Meta-analysis of OS for interim PET/CT visual evaluation of aggressive non-Hodgkin’s lymphoma (subgroups = interpretation criteria).

Note: ‘–’ indicates not available.
Abbreviations: OS, overall survival; PET/CT, positron emission tomography/computed tomography; HR, hazard ratio; CI, confidence interval; IHP, International Harmonization Project; TE, estimate of treatment effect; seTE, standard error of treatment estimate.

Figure 4 Meta-analysis of OS in interim PET/CT visual evaluation of aggressive non-Hodgkin’s lymphoma (subgroups = number of chemotherapy cycles before PET/CT).

Note: ‘–’ indicates not available.
Abbreviations: OS, overall survival; PET/CT, positron emission tomography/computed tomography; HR, hazard ratio; CI, confidence interval; TE, estimate of treatment effect; seTE, standard error of treatment estimate.

Figure 5 Publication bias funnel map (A) and Egger’s test (B) of the data shown in Figure 1.

Figure 6 Publication bias funnel map (A) and Egger’s test (B) of the data shown in Figure 2.

Figure 7 Publication bias funnel map (A) and Egger’s test (B) of the data shown in Figure 3.

Figure 8 Publication bias funnel map (A) and Egger’s test (B) of the data shown in Figure 4.

ZinzaniPLGandolfiLBroccoliAMidtreatment 18F-fluorodeoxyglucose positron-emission tomography in aggressive non-Hodgkin lymphomaCancer201111751010101820960498

 PubMedGoogle Scholar

YooCLeeDHKimJELimited role of interim PET/CT in patients with diffuse large B-cell lymphoma treated with R-CHOPAnn Hematol201190779780221181163

 PubMed Web of Science ®Google Scholar

YangDHMinJJSongHCPrognostic significance of interim 18F-FDG PET/CT after three or four cycles of R-CHOP chemotherapy in the treatment of diffuse large B-cell lymphomaEur J Cancer20114791312131821334197

 PubMed Web of Science ®Google Scholar

SpaepenKStroobantsSDupontPEarly restaging positron emission tomography with (18)F-fluorodeoxyglucose predicts outcome in patients with aggressive non-Hodgkin’s lymphomaAnn Oncol20021391356136312196360

 PubMed Web of Science ®Google Scholar

SafarVDupuisJIttiEInterim [18F]fluorodeoxyglucose positron emission tomography scan in diffuse large B-cell lymphoma treated with anthracycline-based chemotherapy plus rituximabJ Clin Oncol201230218419022162590

 PubMed Web of Science ®Google Scholar

NolsNMounierNBouazzaSQuantitative and qualitative analysis of metabolic response at interim positron emission tomography scan combined with International Prognostic Index is highly predictive of outcome in diffuse large B-cell lymphomaLeuk Lymphoma201455477378023927393

 PubMed Web of Science ®Google Scholar

HaiounCIttiERahmouniA[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting patient outcomeBlood200510641376138115860666

 PubMed Web of Science ®Google Scholar

CashenAFDehdashtiFLuoJHombASiegelBABartlettNL18F-FDG PET/CT for early response assessment in diffuse large B-cell lymphoma: poor predictive value of international harmonization project interpretationJ Nucl Med201152338639221321279

 PubMed Web of Science ®Google Scholar

PregnoPChiappellaABelloMInterim 18-FDG-PET/CT failed to predict the outcome in diffuse large B-cell lymphoma patients treated at the diagnosis with rituximab-CHOPBlood201211992066207322234681

 PubMed Web of Science ®Google Scholar

IttiEMeignanMBerriolo-RiedingerAAn international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma: comparison between Deauville criteria and ΔSUVmaxEur J Nucl Med Mol Imaging20134091312132023649463

 PubMed Web of Science ®Google Scholar

MamotCKlingbielDHitzFFinal results of a prospective evaluation of the predictive value of interim positron emission tomography in patients with diffuse large B-cell lymphoma treated with R-CHOP-14 (SAKK 38/07)J Clin Oncol201533232523252926150440

 PubMed Web of Science ®Google Scholar