{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:46:10Z","timestamp":1790721970987,"version":"4.1.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T00:00:00Z","timestamp":1658966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>We investigated the utility of a new baseline PET parameter expressing lesion dissemination and metabolic parameters for predicting progression-free survival (PFS) and pathologic grade in follicular lymphoma (FL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The baseline <jats:sup>18<\/jats:sup>F-FDG PET\/CT images of 126 patients with grade 1\u20133A FL were retrospectively analyzed. A novel PET\/CT parameter characterizing lesion dissemination, the distance between two lesions that were furthest apart (<jats:italic>D<\/jats:italic><jats:sub>max<\/jats:sub>), was calculated. The total metabolic tumor volume and total lesion glycolysis (TLG) were computed by using 41% of the maximum standardized uptake value (SUV<jats:sub>max<\/jats:sub>) thresholding method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 5-year PFS rate was 51.9% for all patients. In the multivariate analysis, high <jats:italic>D<\/jats:italic><jats:sub>max<\/jats:sub> [<jats:italic>P<\/jats:italic> = 0.046; hazard ratio (HR) = 2.877], high TLG (<jats:italic>P<\/jats:italic> = 0.004; HR = 3.612), and elevated serum lactate dehydrogenase (<jats:italic>P<\/jats:italic> = 0.041; HR = 2.287) were independent predictors of PFS. A scoring system for prognostic stratification was established based on these three adverse factors, and the patients were classified into three risk categories: low risk (zero to one factor, <jats:italic>n<\/jats:italic> = 75), intermediate risk (two adverse factors, <jats:italic>n<\/jats:italic> = 29), and high risk (three adverse factors, <jats:italic>n<\/jats:italic> = 22). Patients in the high-risk group had a shorter 3-year PFS (21.7%) than those in the low- and intermediate-risk groups (90.6 and 44.6%, respectively) (<jats:italic>P<\/jats:italic> &amp;lt; 0.001). The C-index of our scoring system for PFS (0.785) was superior to the predictive capability of the Follicular Lymphoma International Prognostic Index (FLIPI), FLIPI2, and PRIMA-Prognostic Index (C-index: 0.628\u20130.701). The receiver operating characteristic curves and decision curve analysis demonstrated that the scoring system had better differentiation and clinical utility than these existing indices. In addition, the median SUV<jats:sub>max<\/jats:sub> was significantly higher in grade 3A (36 cases) than in grades 1 and 2 FL (90 cases) (median: 13.63 vs. 11.45, <jats:italic>P<\/jats:italic> = 0.013), but a substantial overlap existed (range: 2.25\u201339.62  vs. 3.17\u201339.80).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TLG and <jats:italic>D<\/jats:italic><jats:sub>max<\/jats:sub> represent two complementary aspects of the disease, capturing the tumor burden and lesion dissemination. TLG and <jats:italic>D<\/jats:italic><jats:sub>max<\/jats:sub> are promising metrics for identifying patients at a high risk of progression or relapse. Additionally, SUV<jats:sub>max<\/jats:sub> seems to have some value for distinguishing grade 3A from low-grade FL but cannot substitute for biopsy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.943151","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T06:03:42Z","timestamp":1658988222000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Prediction of prognosis and pathologic grade in follicular lymphoma using 18F-FDG 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