Metabolic Tumor Area: A Clinically Practical Prognostic Marker for Improved Risk Stratification in IPI Non‐High‐Risk DLBCL

ABSTRACT Metabolic tumor volume (TMTV) is a core 18 F‐FDG PET/CT prognostic marker for diffuse large B‐cell lymphoma (DLBCL), but its complex measurement and limited standardization restrict clinical utility. Metabolic tumor area (MTA) features simple operation and good reproducibility, holding potential as a practical alternative to TMTV. This retrospective study aimed to validate MTA's substitutability and explore its prognostic value in DLBCL risk stratification. A total of 295 newly diagnosed DLBCL patients were enrolled. TMTV and MTA were measured via semi‐automatic segmentation (41% SUVmax threshold). Survival analysis, Cox regression, 5‐fold cross‐validation, and time‐dependent ROC curves were used to evaluate prognostic performance. Multivariate analysis revealed MTA, rather than TMTV, independently predicted progression‐free survival (PFS) and overall survival (OS) (all p < 0.05), with stability confirmed by cross‐validation. The combined MTA and D max model provided IPI‐independent prognostic value, and exhibited improved predictive capacity compared with conventional IPI and TMTV and D max model in non‐high‐risk IPI patients (all p < 0.05). It successfully identified occult high‐risk subgroups that were undetectable by standard IPI grading. MTA possesses favorable prognostic performance and may serve as a practical alternative to TMTV for DLBCL assessment. The MTA and D max model complements the traditional IPI system, facilitating refined risk stratification and individualized clinical management. Further validation in multi‐center prospective cohorts is warranted. Trial registration Ethics Committee of Jiangsu Cancer Hospital (Approval KY‐2025‐095, 16 July 2025)