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Aim of this large retrospectively-validated study is to evaluate the predictive role of two-lesions radiomics in comparison with other clinical and conventional PET\/CT models. cHL patients with bPET\/CT between 2010 and 2020 were retrospectively included and randomized into training-validation sets. Target lesions were: Lesion_A, with largest axial diameter (D<jats:sub>max<\/jats:sub>); Lesion_B, with highest SUV<jats:sub>max<\/jats:sub>. Total-metabolic-tumor-volume (TMTV) was calculated and 212 radiomic features were extracted. PET\/CT features were harmonized using ComBat across two scanners. Outcomes were progression-free-survival (PFS) and Deauville Score at interim PET\/CT (DS). For each outcome, three predictive models and their combinations were trained and validated: - radiomic model \u201cR\u201d; - conventional PET\/CT model \u201cP\u201d; - clinical model \u201cC\u201d. 197 patients were included (training\u2009=\u2009118; validation\u2009=\u200979): 38\/197 (19%) patients had adverse events and 42\/193 (22%) had DS\u2009\u2265\u20094. In the training phase, only one radiomic feature was selected for PFS prediction in model \u201cR\u201d (Lesion_B <jats:italic>F_cm.corr<\/jats:italic>, C-index 66.9%). Best \u201cC\u201d model combined stage and IPS (C-index 74.8%), while optimal \u201cP\u201d model combined TMTV and D<jats:sub>max<\/jats:sub> (C-index 63.3%). After internal validation, \u201cC\u201d, \u201cC\u2009+\u2009R\u201d, \u201cR\u2009+\u2009P\u201d and \u201cC\u2009+\u2009R\u2009+\u2009P\u201d significantly predicted PFS. The best validated model was \u201cC\u2009+\u2009R\u201d (C-index 66.3%). No model was validated for DS prediction. In this large retrospectively-validated study, a combination of baseline <jats:sup>18<\/jats:sup>F-FDG PET\/CT two-lesions radiomics and other conventional models showed an added prognostic power in patients with cHL. As single models, conventional clinical parameters maintain their prognostic power, while radiomics or conventional PET\/CT alone seem to be sub-optimal to predict survival.<\/jats:p>","DOI":"10.1007\/s00277-025-06190-8","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T04:53:05Z","timestamp":1736830385000},"page":"641-651","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The predictive power of 18F-FDG PET\/CT two-lesions radiomics and conventional models in classical Hodgkin\u2019s Lymphoma: a comparative retrospectively-validated study"],"prefix":"10.1007","volume":"104","author":[{"given":"Elizabeth Katherine Anna","family":"Triumbari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Morland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Gatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Boldrini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"De Summa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Chiesa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annarosa","family":"Cuccaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Maiolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Hohaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Annunziata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"6190_CR1","doi-asserted-by":"publisher","first-page":"iv19","DOI":"10.1093\/annonc\/mdy080","volume":"29","author":"DA Eichenauer","year":"2018","unstructured":"Eichenauer DA, Aleman BMP, Andr\u00e9 M et al (2018) Hodgkin lymphoma: ESMO Clinical Practice guidelines for diagnosis, treatment and follow-up. 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