Prognostic significance of PET/BT metabolic parameters and correlation with inflammatory biomarkers in hodgkin lymphoma

Aim: In this study, we aimed to investigate the importance of semiquantitative PET metabolic measurements SUVMAX, SUVMEAN, MTV, TLG on prognosis to correctly re-staging different subgroups of patients might be candidate for different treatment approaches with different risk characteristics. We also aimed to investigate the relationship between new inflammatory markers SII, PNI, NLR, and LMR with PET metabolic parameters to contribute to the potential biomarker research process may be meaningful in all stages alternative to IPS7 which is used in advanced stage. Materials&Methods: A total of 142 patients (17-78) who were histopathologically diagnosed as Hodgkin's Lymphoma and least 6 months followed by the Balcalı Training and Research Hospital of Çukurova University Medical Faculty were included in the study retrospectively. Patients who has secondary malignancy and autoimmune disease are excluded. The maximum standardized uptake value (SUVMAX), mean standardized uptake value (SUVMEAN), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and Deauville scores were obtained from pre-treatment, interim and post-treatment PET/CT of 52 patients. Systemic immune inflammation index (SII), prognostic nutritional index (PNI), neutrophil / lymphocyte ratio (NLR), lymphocyte / monocyte ratio (LMR), lymphocyte, neutrophil, monocyte, platelet counts and lymphocyte percentage, B2 microglobulin, LDH levels were evaluated. IPS-7 and IPS-3 scores were calculated. The correlation of PET / CT metabolic parameters and inflammatory biomarkers and their prognostic significance were examined. Results: PET / CT metabolic parameters SUVMAX, SUVMEAN, MTV, TLG of 52 patients were not correlated with OS and PFS before treatment. Patients with positive SUVMAX iPET, MTV iPET, TLG iPET, and Deauville iPET had a worse prognosis. Post-treatment SUVMAX, SUVMEAN, MTV, TLG and Deauville scores were associated with overall survival (OS). Progression-free survival (PFS) was found to be longer in the early-stage favorable-risk group. Patients with bulky disease were found to have shorter PFS than those without bulky disease. Lymphocyte count <1.33, lymphocyte percentage <16.31% , neutrophil/lymphocyte ratio>4.84, lymphocyte/monocyte ratio <2.09 were found to be associated with PFS. There was no statistically significant relationship between LDH, B2 microglobulin and PNI values and PFS. IPS-7, IPS-3 and IPS-4 were associated with OS, IPS-4 was associated with OS and PFS in advanced stage patients. Only IPS-4 was associated with mortality in advanced stage patients. The patient's age >45, B2 microglobulin value> 2.59, lymphocyte count <1.33 and the patient's response to treatment were found to be independent risk factors for survival. Conclusion: This study, which we conducted to increase the predictive value of PET / CT, is the first study comparing PET metabolic parameters with NLR, LMR, SII and PNI in HL in the light of current literature. Although there is no significant relationship between PET metabolic parameters and inflammatory biomarkers examined, it is necessary to investigate prognostic biomarkers that may be significant in all stages . It would be beneficial to validate our data with larger patient groups.