中期^(18)F-FDG PET/CT预测结外弥漫大B细胞淋巴瘤疗效和预后的方法学研究  

Methodological study of interim ^(18)F-FDG PET/CT in predicting efficacy and prognosis in patients with extranodal diffuse large B-cell lymphoma

作　　者：李旭[1] 刘甫庚[1] 陈聪霞[1] 崔燕 冯茹[2] 颜东岳 姚稚明[1] Li Xu;Liu Fugeng;Chen Congxia;Cui Yan;Feng Ru;Yan Dongyue;Yao Zhiming(Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Hematology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院核医学科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院血液科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《国际放射医学核医学杂志》2023年第5期265-273,共9页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的对比分析基于中期^(18)F-氟脱氧葡萄糖(FDG)PET/CT的4项评估指标预测结外弥漫大B细胞淋巴瘤(EN-DLBCL)初始化疗疗效和预后的效能。方法回顾性分析2011年5月至2020年4月于北京医院经组织病理学检查或随访结果明确诊断为EN-DLBCL的77例初诊患者[其中,男性35例、女性42例,年龄(62.7±16.2)岁]的资料,包括治疗前基线PET/CT、初始化疗3~4个周期时的中期PET/CT和临床资料,并通过医院电子病历系统或电话随访。采用受试者工作特征(ROC)曲线确定中期PET/CT的最大标准化摄取值(SUV_(max))的最佳临界值,将患者分为中期SUV_(max)<最佳临界值组和中期SUV_(max)≥最佳临界值组;按照中华医学会核医学分会淋巴瘤^(18)F-FDG PET/CT及PET/MR显像临床应用指南推荐,以ΔSUV_(max)%=70%为最佳临界值,将患者分为ΔSUV_(max)%<70%组和ΔSUV_(max)%≥70%组;根据中期Deauville五分法评分,将患者分为Deauville五分法评分1~3分组和4~5分组;根据Lugano疗效评估标准,以中期疗效将患者分为缓解组和未缓解组。采用χ^(2)检验、Kaplan-Meier生存分析和COX回归分析等方法分析基于中期PET/CT的SUV_(max)、Deauville五分法评分、Lugano疗效评估结果、ΔSUV_(max)%等指标对EN-DLBCL初始化疗疗效和预后预测的效能。结果(1)初始化疗结束时51例(66.2%)患者完全缓解;中期SUV_(max)<4.9组、Deauville五分法评分1~3分组的完全缓解率分别为82.6%(38/46)和85.0%(34/40),显著高于对应的其他组,差异均有统计学意义(χ^(2)=13.699、13.108,均P<0.001);以ΔSUV_(max)70%和Lugano疗效评估结果进行分组的各组,其完全缓解率之间的差异均无统计学意义(χ^(2)=0.018、0.368,均P>0.05)。(2)中位随访时间为24个月,范围为4~105个月,随访结束时19例(24.7%)患者疾病进展、复发或死亡;SUV_(max)<4.9组、Deauville五分法评分1~3分组、Lugano疗效评估缓解组患者的2年无进展生存期(PFS)均显著优于对应的其他组,差异�Objective To investigate the predictive accuracies of four indicators based on the interim ^(18)F-fluorodeoxyglucose(FDG)PET/CT in terms of their efficacy and prognoses in patients with extranodal diffuse large B-cell lymphoma(EN-DLBCL).Methods Data of a total of seventy-seven newly diagnosed patients(35 males,42 females;aged(62.7±16.2)years)with EN-DLBCL confirmed by histopathological examination or follow-up results were retrospectively analyzed from May 2011 to April 2020,including baseline PET/CT before treatment,interim PET/CT during initial chemotherapy for 3 to 4 cycles,and clinical data.Follow-up was performed through the hospital's electronic medical record system or phone call.Using the receiver operating characteristic(ROC)curve to select the optimal cutoff value for interim SUV_(max),patients were divided into SUV_(max)<the cutoff value group and≥the cutoff group.Following the clinical practice guideline of ^(18)F-FDG PET/CT and PET/MR in lymphoma(2021 edition),ΔSUV_(max)=70%was chosen as the cutoff value,patients were divided intoΔSUV_(max)%<70%group and≥70%group.Based on the Deauville five-point scale,patients were divided into 1–3 group and 4–5 group.According to the Lugano classification criteria,patients were divided into the disease remission group and unrelieved group based on the interim response evaluation.Theχ^(2)test,Kaplan-Meier,and Cox regression analysis were performed to analyze SUV_(max),Deauville five-point scale,and the Lugano classification criteria based on interim PET/CT andΔSUV_(max)%between baseline PET and interim PET in order to predict the efficacy of primary chemotherapy and prognosis of EN-DLBCL.Results(1)At the end of primary chemotherapy,51 patients(66.2%)achieved complete remission(CR).The rates of CR in SUV_(max)<4.9 group and Deauville scores 1–3 group were 82.6%(38/46)and 85.0%(34/40),respectively,which were significantly higher than those of the other corresponding groups(χ^(2)=13.699,13.108,both P<0.001).No significant difference was found between th

关 键 词：淋巴瘤 大B细胞 弥漫性 正电子发射断层显像术 体层摄影术 X线计算机 预后 最大标准化摄取值 Deauville五分法 Lugano疗效评估 

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