中期^(18)F-FDG PET/CT显像不同评价方法对弥漫大B细胞淋巴瘤患者预后判断价值  

Values of Different Evaluation Criteria of Interim ^(18)F-FDG PET/CT Scan for Prediction of Prognosis in Patients with DLBCL

作　　者：朱璐婷 岑溪南[1] 欧晋平[1] 邱志祥[1] 王莉红[1] 刘薇[1] 王文生[1] 董玉君[1] 梁赜隐[1] 王茫桔[1] 许蔚林[1] 孙玉华[1] 王倩[1] 尹玥[1] 任汉云[1] 

机构地区：[1]北京大学第一医院血液科,北京100034

出　　处：《中国实验血液学杂志》2017年第2期431-437,共7页Journal of Experimental Hematology

基　　金：国家自然科学基金资助项目(81041002);北京市科委首都临床特色应用研究专项资助课题(Z141107002514017)

摘　　要：目的:探究中期^(18)F-FDG PET/CT(i-PET/CT)显像对弥漫大B细胞淋巴瘤(DLBCL)患者预后判断价值。方法:回顾分析我院70例初治DLBCL患者的158次^(18)F-FDG PET/CT结果,分别采用5分法、Lugano分类和最大标准摄取值减少率(△SUVmax)法评价i-PET/CT。利用受试者操作特性(ROC)曲线确定△SUVmax最佳界值。应用无进展生存(PFS)时间及总生存(OS)时间作为随访指标。运用Kaplan-Meier方法和Cox回归模型进行生存分析。结果:经ROC曲线计算△SUVmax最佳界值点为62%。5分法诊断2年PFS和OS阳性预测值(PPV)低,Lugano分类和△SUVmax法均可提高PPV,但采用Lugano分类敏感度下降。Kaplan-Meier生存曲线分析显示,Lugano分类和△SUVmax法可预测PFS和OS时间,而5分法仅可预测OS时间。COX回归单因素分析示,国际预后指数(IPI)评分对PFS预测仅优于5分法,对OS预测则逊于三者。COX回归多因素分析显示,△SUVmax法是判断预后的独立危险因素,采用Lugano分类仅对OS有独立预后价值。结论:5分法评价i-PET/CT对于DLBCL患者判断预后价值有限,建议结合Lugano分类标准。采用△SUVmax法评价i-PET/CT对DLBCL患者具有独立预后价值,优于IPI评分。Objective： To explore the prognostic value of interim ^18F-FDG PET/CT （i-PET/CT） scan for the patients with newly diagnosed diffuse large B-cell lymphoma （DLBCL）. Methods： A total of 70 cases of initially diagnosed of DLBCL by 158 ^18F-FDG PET/CT scans in our hospital were retrospectively analyzed. The 5 -point scale, the Lugano classification and maximum standardized uptake value induction （ A SUVmax） criteria were used respectively to assess i-PET/CT scans. Receiver-operating characteristics （ROC） analysis was used to determine an optimal cutoff for △SUVmax. Progression-free survival （PFS） and overall survival （OS） times were estimated as prognostic indicators using the Kaplan-Meier method and Cox regression. Results： Optimal cutoff to predict progression or death was 62% for △SUVmax. The positive predictive value （PPV） for 2 -year PFS and OS of i-PET/CT diagnosed by 5 - point scale was low, and could be improved by using the Lugano classification with decreased sensitivity or A SUVmax criteria. Kaplan-Meier survival curve analysis showed that the Lugano classification and △SUVmax were good predictors for PFS and OS, respectively, while the 5 - point scale could only predict OS. Cox regression univariate analysis showed that the International Prognostic Index （IPI） score was better to predict PFS than 5 -point scale, but worse than the three assessments in predicting OS. COX regression multivariate analysis showed that ASUVmax 〈 62% was an independent risk factor of prognosis, while the Lugano classification was only the OS independent prognostic predictor. Conclusion： Assessing i-PET/CT by 5 -point scale is a limited value for predicting PFS and OS in DLBCL patients. The Lugano classification is recommended to discriminate the patients with poorer outcomes. The △SUVmax criteria for i-PET/CT of DLBCL patients is an independent prognostic predictor for PFS and OS, better than the IPI score.

关 键 词：弥漫大B细胞淋巴瘤 中期PET/CT 5分法 Lugano分类 △SUVmax 

分 类 号：R733.1[医药卫生—肿瘤]