Prognostic Value of Combined Baseline FDG PET/CT Radiomic Parameters in Primary Mediastinal B-Cell Lymphoma
Abstract
Primary mediastinal B-cell lymphoma (PMBL) is an uncommon aggressive lymphoma with generally favorable outcomes; however, 15-20% of patients develop refractory disease. Reliable baseline prognostic biomarkers remain lacking. We evaluated the prognostic value of radiomic parameters derived from baseline 18F-FDG PET/CT in newly diagnosed PMBL. This post-hoc analysis included 180 treatment-naïve patients from the multicenter LYSA cohort (2007-2017) treated with rituximab plus ACVBP, R-CHOP14, or R-CHOP21. Twelve 3D PET-derived radiomic features were extracted using Oncometer3D. Inter-parameter correlations were assessed using Spearman coefficients. Receiver operating characteristic (ROC) analyses determined optimal cut-offs. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates and Cox regression models. Four clusters of correlated features were identified: activity, tumor burden, massiveness/fragmentation, and dispersion. Among these, total metabolic tumor volume (TMTV), maximal inter-lesion distance (Dmax), and median peripheral centroid distance (medPCD) demonstrated the strongest prognostic associations. TMTV and Dmax were significantly associated with shorter PFS and OS, while medPCD predicted OS. In multivariable analysis adjusted for IPI, bulky disease, B symptoms, and treatment regimen, a composite radiomic score (2-3 high-risk features vs 0-1) independently predicted OS (HR 7.76, 95% CI 1.59-37.74) and showed a strong trend for PFS. The composite score outperformed conventional clinical risk factors. Baseline PET-derived radiomic features capturing tumor burden, spatial dispersion, and compactness provide independent prognostic information in PMBL. A three-parameter radiomic score outperformed conventional risk factors and identified a high-risk subgroup at diagnosis, warranting prospective and external validation before clinical implementation.
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BibTeX
@article{decazes2026prognostic,
title = {{Prognostic Value of Combined Baseline FDG PET/CT Radiomic Parameters in Primary Mediastinal B-Cell Lymphoma}},
author = {Pierre Decazes and Cedric Rossi and Pierre Sesques and Stéphanie Becker and Mathieu Viennot and Sorina-Dana Mihailescu and François Lemonnier and Eric Durot and Nicolas Gower and Alexandre Willaume and Lucie Obéric and Jérôme Paillassa and Chloe Antier and Loic Renaud and Olivier Tournilhac and Catherine Thieblemont and Caroline Besson and Laure Lebras and Sylvain Choquet and Katell Le Dû and Christophe Bonnet and Sarah Bailly and Gandhi-Laurent Damaj and Kamel Laribi and Nadine Morineau and Roch Houot and Adrien Chauchet and Fabrice Jardin and Hervé Tilly and Elena-Liana Veresezan and Fanny Drieux and Marie Donzel and Alexandra Traverse-Glehen and David Tonnelet and Vincent Camus},
journal = {Blood Advances},
year = {2026},
month = may,
doi = {10.1182/bloodadvances.2026020168},
url = {https://hal.science/hal-05654892v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Prognostic Value of Combined Baseline FDG PET/CT Radiomic Parameters in Primary Mediastinal B-Cell Lymphoma
AU - Pierre Decazes
AU - Cedric Rossi
AU - Pierre Sesques
AU - Stéphanie Becker
AU - Mathieu Viennot
AU - Sorina-Dana Mihailescu
AU - François Lemonnier
AU - Eric Durot
AU - Nicolas Gower
AU - Alexandre Willaume
AU - Lucie Obéric
AU - Jérôme Paillassa
AU - Chloe Antier
AU - Loic Renaud
AU - Olivier Tournilhac
AU - Catherine Thieblemont
AU - Caroline Besson
AU - Laure Lebras
AU - Sylvain Choquet
AU - Katell Le Dû
AU - Christophe Bonnet
AU - Sarah Bailly
AU - Gandhi-Laurent Damaj
AU - Kamel Laribi
AU - Nadine Morineau
AU - Roch Houot
AU - Adrien Chauchet
AU - Fabrice Jardin
AU - Hervé Tilly
AU - Elena-Liana Veresezan
AU - Fanny Drieux
AU - Marie Donzel
AU - Alexandra Traverse-Glehen
AU - David Tonnelet
AU - Vincent Camus
PY - 2026
DA - 2026/05/12
JO - Blood Advances
DO - 10.1182/bloodadvances.2026020168
UR - https://hal.science/hal-05654892v1
AB - Primary mediastinal B-cell lymphoma (PMBL) is an uncommon aggressive lymphoma with generally favorable outcomes; however, 15-20% of patients develop refractory disease. Reliable baseline prognostic biomarkers remain lacking. We evaluated the prognostic value of radiomic parameters derived from baseline 18F-FDG PET/CT in newly diagnosed PMBL. This post-hoc analysis included 180 treatment-naïve patients from the multicenter LYSA cohort (2007-2017) treated with rituximab plus ACVBP, R-CHOP14, or R-CHOP21. Twelve 3D PET-derived radiomic features were extracted using Oncometer3D. Inter-parameter correlations were assessed using Spearman coefficients. Receiver operating characteristic (ROC) analyses determined optimal cut-offs. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates and Cox regression models. Four clusters of correlated features were identified: activity, tumor burden, massiveness/fragmentation, and dispersion. Among these, total metabolic tumor volume (TMTV), maximal inter-lesion distance (Dmax), and median peripheral centroid distance (medPCD) demonstrated the strongest prognostic associations. TMTV and Dmax were significantly associated with shorter PFS and OS, while medPCD predicted OS. In multivariable analysis adjusted for IPI, bulky disease, B symptoms, and treatment regimen, a composite radiomic score (2-3 high-risk features vs 0-1) independently predicted OS (HR 7.76, 95% CI 1.59-37.74) and showed a strong trend for PFS. The composite score outperformed conventional clinical risk factors. Baseline PET-derived radiomic features capturing tumor burden, spatial dispersion, and compactness provide independent prognostic information in PMBL. A three-parameter radiomic score outperformed conventional risk factors and identified a high-risk subgroup at diagnosis, warranting prospective and external validation before clinical implementation.
SN - 2473-9529
SN - 2473-9537
ER -