化疗中期RECIL与Lugano标准在淋巴瘤疗效及预后评价中的对比研究  

Comparative study of RECIL versus Lugano in the evaluation of curative effect and prognosis of lymphoma during mid-chemotherapy

作　　者：于青青 赵铭[1] 原凌[1] 田蓉蓉[1] 苏丽萍[2] 周洁[1] 林艳梅 Yu Qingqing;Zhao Ming;Yuan Ling;Tian Rongrong;Su Liping;Zhou Jie;Lin Yanmei(Department of Nuclear Medicine,Shanxi Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Department of Hematology,Shanxi Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院核医学科,太原030013 [2]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院血液科,太原030013

出　　处：《中华核医学与分子影像杂志》2023年第11期672-677,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：山西省卫生健康委员会科研课题计划(201301092)。

摘　　要：目的对比化疗中期淋巴瘤疗效评价标准(RECIL)与Lugano标准在^(18)F-FDG亲和性高的霍奇金淋巴瘤(HL)和非霍奇金淋巴瘤(NHL)患者中的疗效及预后评价作用。方法回顾性分析2015年1月至2021年8月在山西省肿瘤医院初诊的经病理证实的240例淋巴瘤患者[男149例、女91例,年龄50.0(32.0,62.0)岁],患者均于治疗前及治疗中期行^(18)F-FDG PET/CT显像。比较不同类型淋巴瘤患者PET/CT显像结果差异(χ^(2)检验或Kruskal-Wallis秩和检验)。在化疗中期进行疗效评价,依据Lugano标准,疗效分为完全缓解(CR)、部分缓解(PR)、疾病稳定(SD)、疾病进展(PD);依据RECIL,疗效分为CR、PR、轻微缓解(MiR)、SD、PD。为了更好地与Lugano标准进行比较,将MiR分别纳入PR组(记作RECIL-1)及SD组(记作RECIL-2)。随访分析无进展生存(PFS)情况。采用Kappa检验、χ^(2)检验或Fisher确切概率法分析数据,采用ROC曲线比较不同标准的预测效能。结果240例中,HL 96例、滤泡型淋巴瘤(FL)30例、弥漫性大B细胞淋巴瘤(DLBCL)114例。不同类型淋巴瘤患者的病灶基线SUVmax(H=54.96,P<0.001)、最大径总和(SLD)(H=15.85,P<0.001)的差异均有统计学意义。随访12~89个月,依据RECIL评价时,26例(10.8%)患者评估为MiR。RECIL-1、RECIL-2与Lugano标准在化疗中期疗效评价结果的一致性(Kappa)分别为0.84和0.74(均P<0.001)。依据Lugano标准,CR、PR、SD、PD患者的PFS率分别为91.4%(148/162)、57.1%(36/63)、1/3和3/12;依据RECIL-1的对应结果分别为91.3%(136/149)、62.8%(49/78)、1/2和2/11;依据RECIL-2的对应结果分别为91.3%(136/149)、57.7%(30/52)、71.4%(20/28)和2/11;不同标准各反应类别患者间PFS率的差异有统计学意义(χ^(2)值:46.64~52.44,均P<0.001)。Lugano标准预测PFS的AUC略高于RECIL-1及RECIL-2的AUC(0.774、0.758和0.746;z值:1.28和1.61,P值:0.200和0.107)。结论化疗中期RECIL与Lugano标准对^(18)F-FDG亲和性高的HL和NHL患者疗效及预后评价作用相当。Objective To compare the efficacy and prognostic evaluation of response evaluation criteria in lymphoma(RECIL)and Lugano classification in patients with ^(18)F-FDG-avid Hodgkin′s lymphoma(HL)and non-HL(NHL)during mid-chemotherapy.Methods From January 2015 to August 2021,240 patients(149 males and 91 females,age 50.0(32.0,62.0)years)with pathologically confirmed lymphoma in Shanxi Cancer Hospital were retrospectively analyzed.Pre-treatment and mid-treatment ^(18)F-FDG PET/CT examinations were performed,and the differences of PET/CT imaging results among patients with different types of lymphoma were analyzed(χ^(2) test or Kruskal-Wallis rank sum test).Efficacy evaluation was conducted during mid-chemotherapy,and the results were divided into complete remission(CR),partial remission(PR),stable disease(SD),progressive disease(PD)according to Lugano classification,which were divided into CR,PR,mild remission(MiR),SD,PD according to RECIL.For the better comparison with Lugano classification,MiR was included in PR group(recorded as RECIL-1)and SD group(recorded as RECIL-2)in this study.All patients were followed up,and the progression free survival(PFS)was analyzed.Kappa test,χ^(2) test or Fisher exact probability method were used to analyze the data,and ROC curve was used to compare the prediction efficiency of different standards.Results Among 240 patients with different types of lymphoma(96 HL,30 follicular lymphoma(FL),114 diffuse large B-cell lymphoma(DLBCL)),there were statistically significant differences in baseline SUVmax(H=54.96,P<0.001)and the sum of longest diameters(H=15.85,P<0.001).Patients were followed up for 12-89 months,and 26 patients(10.8%)were evaluated as MiR according to the RECIL.The consistency(Kappa)was 0.84 between results of RECIL-1 and Lugano classification,which was 0.74 between RECIL-2 and Lugano classification(both P<0.001).According to Lugano classification,the PFS rates of patients evaluated as CR,PR,SD and PD were 91.4%(148/162),57.1%(36/63),1/3 and 3/12 respectively,which were 91

关 键 词：淋巴瘤 治疗结果 实体瘤疗效评价标准 氟脱氧葡萄糖F18 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R733.1[医药卫生—肿瘤]