A prognostic survival nomogram for persons with extra-nodal natural killer-/T-cell lymphoma

A novel prognostic model utilizing TMTV and SUVmax from 18F-FDG PET/CT for predicting overall survival in patients with extranodal NK/T- cell lymphoma

BACKGROUND

Survival prediction accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in extra-nodal natural killer/T-cell lymphoma (ENKTL) is controversial. This study aimed to evaluate the prognostic value of 18F-FDG PET/CT parameters including maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG), and to develop a new prognostic model for ENKTL.

METHODS

We analyzed 390 ENKTL patients with comprehensive clinical and survival data. All patients received asparaginase-based chemotherapy with or without radiotherapy, or radiotherapy alone. Metabolic tumor volume (MTV) was calculated using a 41% SUVmax threshold, and TLG was computed as MTV multiplied by the average SUV. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier curves and compared with log-rank tests. Optimal cut-off values were determined using the Youden' index. Cox regression analysis identified significant prognostic factors. A nomogram predicting 1-, 3-, and 5-year survival was developed and validated using the C-index and calibration curves. Statistical significance was set at p < 0.05.

RESULTS

Of the 390 patients, 262 (67.2%) were included in the training set and 128 (32.8%) in the validation set. 18F-FDG PET-CT parameters with cutoff values of SUVmax > 12.8, TMTV > 16.4 cm3, and TLG > 137.0, were significantly associated with poorer OS (p = 0.009) and PFS (p = 0.003). Multivariable Cox regression identified the following as independent predictors of worse OS: age > 60 years (HR = 1.923, 95% CI: 1.001-3.693), presence of B symptoms (HR = 1.861, 1.132-3.059), ECOG score ≥ 2 (HR = 2.076, 1.165-3.699), extranodal involvement ≥ 2 sites (HR = 2.349, 1.384-3.988), bone marrow involvement (HR = 4.884, 2.137-11.163), SUVmax > 12.8 (HR = 2.226, 1.260-3.930), and TMTV > 16.4 cm3 (HR = 1.854, 1.093-3.147). The new prognostic model achieved a C-index of 0.772 for OS and 0.750 for PFS in the training set, and 0.777 for OS and 0.696 for PFS in the validation set. Area under the curve (AUC) values for 1-, 3-, and 5-year OS were 0.841, 0.804, and 0.767 in the training set, and 0.718, 0.786, and 0.893 in the validation set. Risk stratification divided patients into four groups with significant differences in survival (p < 0.001).

CONCLUSION

SUVmax, TMTV, and TLG are independent prognostic factors in ENKTL. Our new model, which integrates 18F-FDG PET/CT metrics with clinical data, enhances survival prediction and may support personalized treatment strategies, though further validation is required.

Diagnostic and prognostic value of pretreatment PET/CT in extranodal natural killer/T-cell lymphoma: a retrospective multicenter study

PURPOSE

The objective of this research was to assess the utility of positron emission tomography combined with computed tomography (PET/CT) to detect bone marrow invasion (BMI) and the predictive value of PET/CT in extranodal natural killer/T-cell lymphoma (ENKTL) patients.

PATIENTS AND METHODS

This multicentre study enrolled ENKTL patients who underwent pretherapy PET/CT and bone marrow biopsy (BMB). The specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) of PET/CT and BMB for BMI were evaluated. Multivariate analysis was used to identify predictive parameters for constructing a nomogram.

RESULTS

Seven hundred and forty-eight patients were identified from four hospitals, with eighty (10.7%) having focal skeletal lesions on PET/CT and fifty (6.7%) having positive BMB. When BMB is considered as the gold standard, the specificity, sensitivity, PPV, and NPV of PET/CT for diagnosing BMI were found to be 93.8%, 74.0%, 46.3%, and 98.1%, respectively. PET/CT-positive individuals showed significantly worse OS than PET/CT-negative patients in the subgroup of BMB-negative cases. The nomogram model created according to the significant risk factors from multivariate analysis performed well in predicting survival probability.

CONCLUSION

PET/CT offers a superior degree of precision for determining BMI in ENKTL. A nomogram model including the parameters of PET/CT can predict survival probability and may help in applying appropriate personalized therapy.

Nomograms referenced by cardiac magnetic resonance in the prediction of cardiac injuries in patients with ST-elevation myocardial infarction

BACKGROUND

Evaluation of cardiac injuries is essential in patients with ST-elevation myocardial infarction (STEMI). Cardiac magnetic resonance (CMR) has become the gold standard for quantifying cardiac injuries; however, its routine application is limited. A nomogram is a useful tool for prognostic prediction based on the comprehensive utilization of clinical data. We presumed that the nomogram models established using CMR as a reference could precisely predict cardiac injuries.

METHODS

This analysis included 584 patients with acute STEMI from a CMR registry study for STEMI (NCT03768453). The patients were divided into training (n = 408) and testing (n = 176) datasets. The least absolute shrinkage and selection operator method and multivariate logistic regression were used to construct nomograms for predicting left ventricular ejection fraction (LVEF) ≤40%, infarction size (IS) ≥ 20% on the LV mass, and microvascular dysfunction.

RESULTS

The nomogram for predicting LVEF≤40%, IS≥20%, and microvascular dysfunction comprised 14, 10, and 15 predictors, respectively. With the nomograms, the individual risk probability of developing specific outcomes could be calculated, and the weight of each risk factor was demonstrated. The C-index of the nomograms in the training dataset were 0.901, 0.831, and 0.814, respectively, and were comparable in the testing set, showing good nomogram discrimination and calibration. The decision curve analysis demonstrated good clinical effectiveness. Online calculators were also constructed.

CONCLUSIONS

With the CMR results as the reference standard, the established nomograms demonstrated good effectiveness in predicting cardiac injuries after STEMI and could provide physicians with a new option for individual risk stratification.