Baseline and interim 18F-FDG PET/CT imaging in outcome prediction in adult patients with Hodgkins lymphoma

To investigate the prognostic value of baseline and interim Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters, including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and Deauville score, in adult patients with Hodgkin lymphoma (HL). A single-center retrospective study included adult patients with HL who underwent baseline and interim 18F-FDG PET/CT scans after four chemotherapy cycles from December 2018 to October 2025. Baseline and interim PET/CT parameters (SUVmax, SUVmean, MTV, TLG) were collected, and interim response was assessed using the Deauville score. Overall survival (OS) and progression-free survival (PFS) were analyzed using receiver operating characteristic (ROC) analysis, Kaplan-Meier survival analysis, and Cox regression models. A total of 116 patients were included (81 males, 35 females), with a median age of 35 years and a median follow-up of 44 months (IQR 37–58). ROC analysis first established the individual prognostic performance and optimal cut-off values for PET parameters, with interim MTV and TLG achieving AUCs of 0.891 and 0.896 for OS, respectively (cut-offs: 21.8 cm³ and 94.4 g). Subsequently, multivariable Cox regression identified baseline MTV, interim MTV, and the Deauville score as significant independent predictors of PFS. Finally, based on these independent factors, combined models were evaluated; however, they yielded AUCs of 0.901 (95% CI: 0.857–0.943) for OS and 0.824 (95% CI: 0.745–0.902) for PFS, which showed comparable efficacy and did not significantly surpass the predictive power of individual quantitative metrics. While similar trends for interim MTV and the Deauville score were observed for OS, the analysis was constrained by the small number of death events. Baseline and interim 18F-FDG PET/CT parameters-particularly interim MTV and Deauville score-were associated with survival outcomes in adult HL. Quantitative interim PET metrics may complement standard visual assessment for risk stratification.