Abstract
INTRODUCTION: Staging with [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (PET) is standard of care in classic Hodgkin lymphoma (cHL). Metabolic tumor volume (MTV) is a quantitative biomarker of tumor burden and has been shown to predict treatment response. This study investigates the association between MTV at baseline PET and health-related quality of life (HRQoL) across different disease stages. METHODS: This post-hoc analysis included 441 patients with newly diagnosed cHL and available baseline PET imaging, enrolled in the GHSG trials HD16, HD17, and HD18. MTV was quantified using a fixed threshold of SUV ≥ 4.0 (SUV4.0) via the LifeX Analytics workstation. HRQoL was assessed using the EORTC QLQ-C30 questionnaire at baseline and, for HD18 patients, again at 2-year follow-up. Multiple regression models adjusted for sex, age, and trial/stage were used for statistical analyses. RESULTS: Higher MTV was associated with higher baseline HRQoL burden across several domains: fatigue (β = 0.14, 95% CI [0.05; 0.24]), dyspnea (β = 0.21, 95% CI [0.11; 0.30]), appetite loss (β = 0.13, 95% CI [0.03; 0.23]), and sleep disturbance (β = 0.12, 95% CI [0.02; 0.22]). In contrast, higher MTV was negatively associated with physical functioning (β = -0.18, 95% CI [-0.27; -0.08]) and global health status (β = -0.15, 95% CI [-0.25; -0.06]). The strongest associations were observed in patients with advanced-stage disease (HD18). At 2-year follow-up in HD18, no associations between MTV at baseline and HRQoL were found, with the exception of pain, which remained the only associated domain (β = 0.15, 95% CI [0.00; 0.30]). CONCLUSION: Baseline MTV is strongly associated with HRQoL before therapy in patients with newly diagnosed cHL, particularly in those with advanced-stage disease. Reassuringly, there seems to be no major influence of initial disease burden on HRQoL within the second year of recovery. TRIAL REGISTRATION: ClinicalTrials.gov: HD16 (NCT00736320; first posted August 15, 2008), HD17 (NCT01356680; first posted May 19, 2011), HD18 (NCT00515554; first posted August 13, 2007).