PET imaging biomarkers predict survival in peripheral T-cell lymphoma: A systematic review and meta-analysis.
Notice bibliographique
Résumé
Abstract Background Peripheral T-cell lymphomas (PTCLs) are aggressive and heterogeneous lymphoid malignancies with poor prognoses and limited response durability using CHOP-based regimens. Recent studies suggest that PET/CT-derived biomarkers—including total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), and Deauville scores (DS) at interim and end-of-treatment (EOT)—may hold prognostic value, yet they are not uniformly incorporated into clinical decision-making. As frontline regimens like BV-CHP become more widely adopted, identifying reliable predictors of outcomes is critical. We hypothesized that PET-based biomarkers—TMTV, TLG, and DS—are significantly associated with overall survival (OS) and progression-free survival (PFS) in patients with nodal PTCL treated with CHOP-like or BV-CHP regimens. Methods This systematic meta-analysis (PROSPERO CRD420251041744) identified 196 articles via systematic search of PubMed and Cochrane searches. Inclusion criteria were treatment-naive adults with nodal PTCL treated with CHOP-like BV-CHP regimens studies reporting hazard ratios (HRs) for OS or PFS associated with baseline TMTV, TLG, or DS. Exclusion criteria included case reports, pediatric studies, non-English publications, and studies involving other lymphoma subtypes, ENKTL, cutaneous T-cell lymphomas, and other mature lymphoid neoplasms. Ten studies met the criteria. Five reviewers screened and extracted data. PET variables were dichotomized as study specific threshold of high vs. low (TMTV,) and DS 4–5 vs. 1–3 for interim and EOT comparisons. We conducted Meta-analyses using RevMan 7.2.0 software, inverse-variance methods and random-effects models. Heterogeneity was assessed via I² and τ² (REML). Results Out of 10 eligible studies 9 were retrospective, and ECHELON-2 (E-2) study was prospective with prespecified assessment of PET response using DS. CHOP-like regimens were used in 1075 patients (including 226 from the matched E-2 cohort), while 226 were treated with BV-CHP in E2. The pooled median age was 58.5 years, predominantly male (61.8%) with advanced-stage disease (88.6% Stage III/IV). Patient distribution between low-risk (IPI 0-2) and high-risk (IPI 3-5) groups was balanced. Follow-up duration ranged from 17 to 65.8 months; the estimated pooled median follow-up was 38 months. Baseline TMTV was evaluated in seven studies (n = 680) and was significantly associated with inferior PFS (pooled HR 2.78 [95% CI: 1.24–6.24]; p = 0.01; I² = 88%). Baseline TMTV also correlated with OS across five studies (HR 2.43 [95% CI: 1.49–3.97]; p = 0.0004; I²=83 %). TLG, reported in three studies (n = 254), was associated with worse OS (HR 3.07 [95% CI: 1.29–7.34]; p = 0.01; I² = 73%). Higher baseline SUV was variably associated with OS and PFS across studies, but without consistent statistical significance. DS high at interim PET (6 studies; n = 698) was strongly associated with PFS (HR 3.40 [95% CI: 2.54–4.54]; p < 0.00001; I² = 13%) and OS (HR 3.62 [95% CI: [2.05- 6.38]; p < 0.00001; I²= 65%). DS high at end-of-treatment (EOT) was even more predictive of OS (pooled HR 5.89 [95% CI: 2.15-16.14]; p < 0.0006; I² = 66%) and PFS (HR 4.29 [95% CI: 1.96–9.39]; p < 0.0003; I²=61 %). DS 1–3 was consistently associated with durable remissions, while DS 4–5 often identified primary refractory . Conclusions This meta-analysis confirms that PET-based imaging biomarkers—particularly TMTV, TLG, and DS are significantly associated with OS and PFS in patients with nodal PTCL treated with CHOP or BV-CHP. DS 4–5 at EOT showed the strongest predictive value across cohorts. These findings support incorporating PET biomarkers into clinical risk models and future trials. Limitations include inter-study heterogeneity, mostly retrospective designs, variability in PET methods and cutoff definitions. Prospective validation of optimal cutoffs, and integration with molecular classifiers are needed to refine risk-adapted therapy in PTCL.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,021 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,014 | 0,025 |
| Bibliométrie | 0,006 | 0,008 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».