^18F-FDG PET/CT代谢参数判断Ⅱ~Ⅲ期弥漫大B细胞淋巴瘤的预后价值  

Prognostic value of ^18F-FDG PET/CT metabolic parameters in patients with diffuse large B-cell lymphoma of stage Ⅱ~Ⅲ disease

作　　者：丁重阳[1] 丁磊 李天女[1] 柳卫[1] 唐立钧[1] Ding Chongyang;Ding Lei;Li Tiannyu;Liu Wei;Tang Lijun(Department of Nuclear Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of CT/MRI,Suzhou First People's Hospital,Suzhou 234000,China)

机构地区：[1]南京医科大学第一附属医院核医学科,210029 [2]安徽省宿州市第一人民医院CT/MRI室,234000

出　　处：《国际放射医学核医学杂志》2019年第3期203-209,共7页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的探讨Ⅱ~Ⅲ期弥漫大B细胞淋巴瘤(DLBCL)治疗前^18F-FDG PET/CT显像中最大标准化摄取值(SUVmax)、代谢体积(MTV)和病灶糖酵解总量(TLG)的预后价值。方法回顾性分析2009年6月至2015年12月诊治的85例初诊Ⅱ~Ⅲ期DLBCL患者的临床资料及治疗前^18F-FDG PET/CT显像资料。以SUVmax的41%作为阈值,得出病灶的SUVmax、MTV和TLG。由受试者工作特征(ROC)曲线判断SUVmax、MTV及TLG预测无进展生存期(PFS)的最佳界值点。采用Kaplan-Meier法进行生存分析,单因素分析采用Log-rank检验,多因素生存分析采用Cox比例风险模型。结果85例DLBCL患者的SUVmax、MTV及TLG的中位数分别为23.9(16.3)、25.1(95.3) cm^3、424.4(1404.6)。ROC曲线分析结果显示:SUVmax的曲线下面积(AUC)= 0.610(95%CI=0.483~0.736,P=0.109),MTV的AUC=0.729(95%CI=0.621~0.838,P=0.001),TLG的AUC=0.726(95%CI=0.621~0.831,P=0.001)。由于SUVmax的AUC较小,不能通过ROC曲线分析获得界值点,因此以SUVmax的中位数23.9作为界值点进行分组。MTV的界值点为39.1 cm^3(灵敏度为73.1%,特异度为69.5%);TLG的界值点为404.5(灵敏度为80.8%,特异度为61.0%)。单因素分析结果显示:Ann Arbor分期、β-2微球蛋白、乳酸脱氢酶、大肿块、国际预后指数(IPI)、SUVmax、MTV、TLG是Ⅱ~Ⅲ期DLBCL患者PFS的影响因素(χ^2=19.118,P=0.000;χ^2=12.310,P=0.000;χ^2=4.861,P=0.027;χ^2=7.731, P=0.013;χ^2=19.693, P=0.000;χ^2=6.414, P=0.011;χ^2=14.538,P=0.000;χ^2=13.089, P=0.000)。Ann Arbor分期、β-2微球蛋白、大肿块、IPI、MTV、TLG是患者总体生存期(OS)的影响因素(χ^2=14.550, P=0.000;χ^2=5.473, P=0.019;χ^2=5.643, P=0.018;χ^2=15.943, P=0.000;χ^2=13.877, P=0.000;χ^2=12.677, P=0.000)。由于MTV与TLG呈高度相关,多因素分析时,二者中仅纳入了TLG,结果显示乳酸脱氢酶、TLG是影响患者PFS的独立危险因素(RR=4.891, 95%CI=1.332~11.955,P=0.017;RR=0.195, 95%CI=0.058~0.660,P=0.009),IPI、TLG是影响患者OS的独立危险因素(RR=0.508, 95%CI=0.Objective To investigate the prognostic value of the maximum standardized uptake value(SUVmax), metabolic tumor volume(MTV) and total lesion glycolysis(TLG) calculated from pretreatment ^18F-FDG PET/CT results in patients with diffuse large B-cell lymphoma of stage Ⅱ~Ⅲ disease. Methods A total of 85 patients with DLBCL of stage Ⅱ~Ⅲ disease were enrolled from June 2009 to December 2015, and the clinic data and pretreatment ^18F-FDG PET/CT data were retrospectively analyzed. MTV and TLG of tumor tissue were calculated from PET/CT images with the threshold value of 41% of the SUVmax. The optimal cutoff point of progression-free survival(PFS) of SUVmax, MTV and TLG were investigated by using receiver operating characteristic(ROC) curve analysis. The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis, and COX proportional hazards model for multivariate analysis. Results The SUVmax, MTV and TLG of 85 patients were 23.9(16.3), 25.1(95.3) cm^3, 424.4(1404.6), respectively. ROC curve showed that the area under the curce(AUC) of SUVmax, MTV and TLG were 0.610, 0.729 and 0.726(95% CI: 0.483 -0.736, P=0.109;0.621 --0.838, P=0.001;0.621 -0.831, P=0.001), respectively. The median SUVmax(23.9) was used as the cutoff points due to smaller AUC of SUVmax. The cutoff point of MTV was 39.1 cm^3(sensitivity=73.1% and specificity=69.5%), and the cutoff point of TLG was 404.5(sensitivity=80.8% and specificity= 61.0%). Univariate analysis showed that Ann Arbor stage,β-2 MG, lactate dehydrogenase(LDH) level, bulky disease, international prognostic index(IPI), SUVmax, MTV and TLG were relative factors affecting PFS(χ^2 =19.118, P=0.000;χ^2=12.310, P=0.000;χ^2=4.861, P=0.027;χ^2=7.731, P=0.013;χ^2=19.693, P=0.000;χ^2=6.414, P=0.011;χ^2=14.538, P=0.000;χ^2=13.089, P=0.000), and Ann Arbor stage,β-2 MG, bulky disease, IPI, MTV and TLG were relative factors affecting overall survival(OS)(χ^2 =14.550, P=0.000;χ^2=5.473, P=0.019;χ^2=5.643, P=0.018;χ^2=15.943, P=0.000;�

关 键 词：淋巴瘤 B细胞 正电子发射断层显像计算机体层摄影术 氟脱氧葡萄糖F18 预后 

分 类 号：R733.1[医药卫生—肿瘤] R730.44[医药卫生—临床医学]