治疗中期^(18)F-FDG PET/CT结合Bcl-2/MYC蛋白双表达在原发胃肠道弥漫性大B细胞淋巴瘤患者危险度分层中的价值  

Role of interim^(18)F-FDG PET/CT combined with Bcl-2/MYC protein dual expression status in risk stratification for patients with primary gastrointestinal diffuse large B-cell lymphoma

作　　者：蒋冲 滕月 来瑞鹤 孙一文[1] 李爱梅[1] 许守林[1] Jiang Chong;Teng Yue;Lai Ruihe;Sun Yiwen;Li Aimei;Xu Shoulin(Department of Nuclear Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院核医学科,210008

出　　处：《中华核医学与分子影像杂志》2021年第7期415-419,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的:探讨中期^(18)F-脱氧葡萄糖(FDG)PET/CT评估结合B细胞淋巴瘤-2(Bcl-2)/MYC蛋白双表达在原发胃肠道弥漫性大B细胞淋巴瘤(PGI-DLBCL)危险度分层中的价值。 方法:回顾性分析2012年6月至2019年5月间南京鼓楼医院46例PGI-DLBCL患者的资料,其中男21例、女25例,年龄20~83岁。利用免疫组织化学法分析所有患者Bcl-2及MYC蛋白表达。患者均行基线及治疗中期[2~4周期利妥昔单克隆抗体+环磷酰胺+多柔比星+长春新碱+泼尼松(R-CHOP)方案化疗]PET/CT评估。采用Deauville 5分法(DS)和最大标准摄取值(SUV max)变化率(ΔSUV max%)进行中期评估。采用Kaplan-Meier生存分析、单因素和多因素Cox比例风险回归模型对3年无进展生存(PFS)率及3年总生存(OS)率进行预后分析。 结果:随访6~84个月,进展14例,死亡9例。患者PFS率为69.6%,OS率为80.4%。Bcl-2/MYC蛋白双表达、DS和ΔSUV max%为PFS预测因子[风险比( HR)值:3.280、5.120和9.167,均 P<0.05],乳酸脱氢酶(LDH)水平、MYC蛋白表达、DS及ΔSUV max%是OS的预测因子( HR值:4.091、9.618、7.697和11.151,均 P<0.05);多因素分析显示DS及ΔSUV max%是PFS和OS的独立预测因子[ HR值:4.370~9.244,均 P<0.05]。预后再分层结果显示,DS阴性患者( n=33)中,双表达阳性者的PFS率及OS率均较阴性者低[PFS率:50.0%与88.9%;OS率:66.7%与96.3%;χ^(2)值:6.050和4.966,均 P<0.05],而在ΔSUV max%<90%患者( n=24)中,双表达阳性者仅3年PFS率较阴性患者低(12.5%与68.8%;χ^(2)=6.649, P=0.01)。 结论:DS和ΔSUV max%是PGI-DLBCL治疗中期预后的独立预测因素,DS、ΔSUV max%与双表达结合可更好地对患者进行危险度分层。Objective To explore the potential value of interim^(18)F-fluorodeoxyglucose(FDG)PET/CT combined with B-cell lymphoma-2(Bcl-2)/MYC protein dual expression(DE)status in the prognostic stratification for patients with primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL).Methods Forty-six patients(21 males,25 females;age 20-83 years)with newly diagnosed PGI-DLBCL from June 2012 to May 2019 in Nanjing Drum Tower Hospital were enrolled in this retrospective study.Immunohistochemistry for Bcl-2 and MYC protein expression was performed.All patients underwent baseline and interim(after 2-4 cycles of cyclophosphamide,doxorubicin,vincristine,prednisone,and rituximab(R-CHOP)regimen)^(18)F-FDG PET/CT scans for assessment.Interim^(18)F-FDG PET/CT results were determined based on Deauville 5-point scale(DS)and changing rate of maximum standardized uptake value(ΔSUVmax%)in^(18)F-FDG PET/CT images.Kaplan-Meier survival analysis,Cox proportional hazards regression model(single factor,multiple factors analysis)were used to analyze the prognosis(3-year progression free survival(PFS)and overall survival(OS)rates).Results Patients were followed up for 6-84 months,and 14 showed disease progression and 9 died.The PFS rate and OS rate were 69.6%and 80.4%,respectively.DE,DS as well asΔSUVmax%were significant predictors of PFS(hazard ratio(HR)values:3.280,5.120,9.167,all P<0.05);lactate dehydrogenase(LDH),MYC protein expression,DS andΔSUVmax%were significant predictors of OS(HR values:4.091,9.618,7.697,11.151,all P<0.05).Multivariate analysis revealed that DS andΔSUVmax%were independent predictors of PFS and OS(HR values:4.370-9.244,all P<0.05).In the DS negative(-)group,patients with DE positive(+)had lower PFS and OS rates than those with DE-(PFS rate:50.0%vs 88.9%;OS rate:66.7%vs 96.3%;χ^(2) values:6.050,4.966,both P<0.05).InΔSUVmax%<90%group,patients with DE+had lower PFS rate than those with DE-(12.5%vs 68.8%;χ^(2)=6.649,P=0.01).Conclusions Interim PET/CT analysis using DS andΔSUVmax%is able to predict survival i

关 键 词：淋巴瘤 大B细胞 弥漫性 胃肠道 BCL-2蛋白 MYC蛋白 正电子发射断层显像术 体层摄影术 X线计算机 脱氧葡萄糖 

分 类 号：R735[医药卫生—肿瘤]