This retrospective analysis of the phase III GOYA study investigated the prognostic value of baseline metabolic tumor volume parameters and maximum standardized uptake values for overall and progression-free survival (PFS) in treatment-naïve diffuse large B-cell lymphoma. Baseline total metabolic tumor volume (determined for tumors >1 mL using a threshold of 1.5 times the mean liver standardized uptake value +2 standard deviations), total lesion glycolysis, and maximum standardized uptake value positron emission tomography data were dichotomized based on receiver operating characteristic analysis and divided into quartiles by baseline population distribution. Of 1,418 enrolled patients, 1,305 had a baseline positron emission tomography scan with detectable lesions. Optimal cut-offs were 366 cm3 for total metabolic tumor volume and 3,004 g for total lesion glycolysis. High total metabolic tumor volume and total lesion glycolysis predicted poorer PFS, with associations retained after adjustment for baseline and disease characteristics (high total metabolic tumor volume hazard ratio: 1.71, 95% confidence interval [CI]: 1.35- 2.18; total lesion glycolysis hazard ratio: 1.46; 95% CI: 1.15-1.86). Total metabolic tumor volume was prognostic for PFS in subgroups with International Prognostic Index scores 0-2 and 3-5, and those with different cell-of-origin subtypes. Maximum standardized uptake value had no prognostic value in this setting. High total metabolic tumor volume associated with high International Prognostic Index or non-germinal center B-cell classification identified the highest-risk cohort for unfavorable prognosis. In conclusion, baseline total metabolic tumor volume and total lesion glycolysis are independent predictors of PFS in patients with diffuse large B-cell lymphoma after first-line immunochemotherapy.

1st Department of Medicine Charles University General Hospital Prague Czech Republic

4th Department of Internal Medicine Hematology Charles University Hospital and Faculty of Medicine Hradec Králové Czech Republic

BC Cancer Centre for Lymphoid Cancer and the University of British Columbia Vancouver BC

Cross Cancer Institute University of Alberta Edmonton AB

Department of Medical Oncology Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs National Cancer Center Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing

Department of Patient Safety and Management Kindai University Hospital and Department of Hematology and Rheumatology Kindai University Faculty of Medicine Osaka

Department of Radiology and Medical Imaging University of Virginia Charlottesville VA

Department of translational and precision medicine Sapienza University Rome

F Hoffmann La Roche Ltd Basel

Fudan University Shanghai Cancer Center Shanghai

Genentech Inc South San Francisco CA

Hematology Oncology Istituto Nazionale Tumori Fondazione G Pascale IRCCS Naples

Institut Català d'Oncologia Institut d'Investigació Biomédica de Bellvitge Universitat de Barcelona Hospitalet de Llobregat Barcelona

Multidisciplinary Oncology Outpatient Clinic Candiolo Cancer Institute FPO IRCCS Candiolo Turin

Universitaria San Martino Genoa

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