Prognosis prediction in non‐Hodgkin lymphoma by assessing lymphoid organs uptake patterns using baseline <scp>¹⁸F</scp>‐<scp>FDG PET</scp>/<scp>CT</scp>

The prognostic implications of lymphoid organs (LOs) involvement in untreated non-Hodgkin lymphoma (NHL) patients remain underexplored. This study aims to explore the significance of LOs metabolic activity, assessed via ¹⁸F-FDG PET/CT, in predicting the early treatment response and prognosis of NHL patients. A retrospective analysis was conducted on ¹⁸F-FDG PET/CT imaging data of untreated NHL patients from March 2016 to December 2023. Metabolic activity levels of LOs were evaluated and scored. Prognostic parameters included the international prognostic index (IPI), progression-free survival (PFS), overall survival (OS), and the interim efficacy evaluation. The median follow-up time was 15 months. The survival analysis was conducted using Kaplan-Meier and Cox regression methods. We included a total of 125 NHL patients (63 ± 12 years) with baseline ¹⁸F-FDG PET/CT scans. Based on the metabolic scores of LOs, patients were divided into three groups: 36 (28.8%) in the low metabolism group, 64 (51.2%) in the intermediate metabolism group, and 25 (20.0%) in the high metabolism group. LOs metabolic scores emerged as an independent prognostic factor. Patients with high metabolic activity in LOs had significantly shorter PFS and OS compared to those with lower activity (OS HR = 4.56; PFS HR = 3.87; p <0.01). The combination of LOs metabolism and extra-LOs tumor burden can further stratify the risk in NHL patients. Metabolic activity in LOs in ¹⁸F-FDG is a vital prognostic indicator and may predict early treatment response in NHL patients. The incorporation of LOs metabolic assessment into clinical practice could enable more accurate prognosis and tailored treatment strategies.