Baseline whole-body metabolic tumor volume as an independent prognostic marker in diffuse large B-cell lymphoma: a PET/cT-based study

Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with variable outcomes despite standard treatments. This study aimed to evaluate the prognostic significance of whole-body metabolic tumor volume and total lesion glycolysis (WB-MTV, WB-TLG) obtained from positron emission tomography/computed tomography (PET/CT) in DLBCL patients at staging. Seventy patients were included. Univariate-multivariate Cox analyses were performed to identify independent prognostic factors. WB-MTV was correlated with disease stage and negatively correlated with PFS and OS, indicating that higher WB-MTV was linked to more advanced disease and poorer outcomes. In multivariate analysis, age ≥72, and WB-MTV > 177.51 cm³ were independently associated with shorter PFS and OS (p < 0.001), indicating that older age and greater WB-MTV increase the risk of disease progression and mortality. However, WB-TLG’s effect was not significant. Age and baseline WB-MTV are independent prognostic markers. This study demonstrated that baseline WB-MTV can be used for risk stratification and may guide treatment selection; therefore, it should be given greater consideration in clinical practice.