Prognostic Value of Combined Baseline FDG PET/CT Radiomic Parameters in Primary Mediastinal B-Cell Lymphoma

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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Journal
Blood Advances
Published
2026-05-12
DOI
https://doi.org/10.1182/bloodadvances.2026020168
Primary Topic
Lymphoma Diagnosis and Treatment
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article
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article

Prognostic Value of Combined Baseline FDG PET/CT Radiomic Parameters in Primary Mediastinal B-Cell Lymphoma

Gandhi-Laurent Damaj, Jérôme Paillassa, Chloé Antier, Nicolas Gower et al.
Blood Advances
Lymphoma Diagnosis and Treatment
article

Prognostic Value of Combined Baseline FDG PET/CT Radiomic Parameters in Primary Mediastinal B-Cell Lymphoma

Gandhi-Laurent Damaj, Jérôme Paillassa, Chloé Antier, Nicolas Gower, Lucie Obéric, Adrien Chauchet, Alexandre Willaume, Sorina‐Dana Mihailescu, Mathieu Viennot, Olivier Tournilhac, Fanny Drieux, Loïc Renaud, Nadine Morineau, David Tonnelet, Pierre Decazes, Sarah Bailly, Stéphanie Becker, C Thieblemont, Pierre Sesques, Laure Lebras, Kamel Laribi, Caroline Besson, Marie Donzel, François Lemonnier, Sylvain Choquet, Fabrice Jardin, Katell Le Dû, Christophe Bonnet, Alexandra Traverse-Glehen, Roch Houot, Elena-Liana Veresezan, Hervé Tilly, Vincent Camus, Eric Durot, Cedric Rossi
article en

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.

Blood Advances
Cliniques Universitaires Saint-Luc (BE), Université de Bourgogne (FR), Centre Hospitalier Universitaire de Lille (FR), Centre Hospitalier Universitaire de Toulouse (FR), Sorbonne Université (FR), Centre Hospitalier Universitaire de Besançon (FR), Hôpital Cochin (FR), Assistance Publique – Hôpitaux de Paris (FR), Hospices Civils de Lyon (FR), University of Clermont Auvergne (FR), Centre Hospitalier Universitaire de Reims (FR), Roche (France) (FR), Centre Hospitalier Universitaire d'Angers (FR), Hôpital Lyon Sud (FR), Pitié-Salpêtrière Hospital (FR), Centre de Recherche en Cancérologie de Lyon (FR), Centre Hospitalier du Mans (FR), Hôpital Robert-Debré (FR), Centre Hospitalier Universitaire de Clermont-Ferrand (FR), Centre Hospitalier Universitaire de Liège (BE), Hôpital privé du Confluent (FR), Hôpital Saint-Louis (FR), Centre Hospitalier Départemental Vendée (FR), Centre Hospitalier Universitaire de Rennes (FR), Centre Hospitalier de Versailles (FR), Hôpital Saint-Vincent-de-Paul (FR), Centre Henri Becquerel (FR), Université Bourgogne Europe (FR), Université de Reims Champagne-Ardenne (FR), Nantes Université (FR), Université de Caen Normandie (FR)
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Lymphoma Diagnosis and Treatment
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