Prognostic Value of Massiveness Parameters Measured on Baseline FDG PET in Advanced‐Stage Hodgkin Lymphoma

Purpose The prognostic value of radiomic quantitative features measured on pretreatment 18 F‐FDG PET/CT was investigated in patients with advanced‐stage Hodgkin lymphoma (HL). Methods We conducted a retrospective study of 176 HL patients diagnosed between 2006 and 2017. A dozen of PET/CT‐derived features were extracted via Oncometer3D from baseline 18 F‐FDG PET/CT images. The receiver operating characteristic (ROC) curves, Kaplan–Meier method, and Cox analyses were used to assess the prognostic factors for Overall Survival (OS) and Progression‐Free Survival (PFS) censored at 5 years. Results Four different clusters were identified among the 12 PET parameters analyzed: activity, tumor burden, fragmentation‐massiveness, and dispersion. On ROC analyses, medEdgeD, a massiveness parameter, had the highest AUC for OS (0.72) and PFS (0.6). Patients with high baseline medEdgeD had a significantly worse PFS ( p = 0.04) and OS ( p = 0.003) in both Kaplan–Meier and Cox univariate analyses. Furthermore, medEdgeD remained statistically significant in a multivariate analysis ( p = 0.008 for OS and p = 0.014 for PFS) including various TEP and clinical parameters used in daily routine. In addition, in sub‐group analyses, a significantly worse prognosis was observed for patients with ABVD and with high baseline medEdgeD value ( p = 0.0082 for OS and p = 0.001 for PFS). Moreover, in the bulky subgroup, medEdgeD improved prognostic accuracy ( p = 0.016). Conclusion PET parameters describing massiveness, in particular medEdgeD, are significantly correlated with prognosis in HL patients for OS and PFS, especially when treated with ABVD.