基线PET代谢参数联合Bcl-2/c-Myc蛋白双表达在预测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  

Prognostic stratification of baseline PET metabolic parameters combined with Bcl-2/c-Myc dual expression in patients with primary gastrointestinal diffuse large B-cell lymphoma

作　　者：蒋冲 来瑞鹤 孙一文[1] 李爱梅[1] 丁重阳[2] 滕月 Jiang Chong;Lai Ruihe;Sun Yiwen;Li Aimei;Ding Chongyang;Teng Yue(Department of Nuclear Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Nuclear Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京大学医学院附属鼓楼医院核医学科,南京210008 [2]南京医科大学第一附属医院核医学科,南京210029

出　　处：《中华核医学与分子影像杂志》2023年第12期730-735,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探索基线PET代谢参数联合B淋巴细胞瘤-2(Bcl-2)/细胞-髓细胞瘤病毒癌基因(c-Myc)蛋白双表达(DE)在预测原发胃肠道弥漫性大B细胞淋巴瘤(PGI-DLBCL)患者危险度分层中的价值。方法回顾性分析2011年3月至2019年11月间南京大学医学院附属鼓楼医院和南京医科大学第一附属医院74例经病理证实为PGI-DLBCL的患者(男33例、女41例,年龄20~87岁),患者治疗前均接受基线PET/CT检查。利用SUVmax≥2.5作为病灶边界进行自动勾画,计算肿瘤代谢体积(MTV)和病灶糖酵解总量(TLG)。利用免疫组织化学法分析患者Bcl-2及c-Myc蛋白表达;建立包含MTV和DE的预后预测模型,将患者分为3组:低危组(低MTV和非DE)、中危组(高MTV或DE)和高危组(高MTV和DE)。采用Kaplan-Meier生存分析、log-rank检验、多因素Cox比例风险回归模型对无进展生存(PFS)及总生存(OS)进行预后分析。结果74例患者中,20例复发或进展、13例死亡,29.7%(22/74)的患者DE阳性。多因素分析结果提示,MTV[风险比(HR)=9.110,95%CI:1.429~18.615,P=0.012]和DE(HR=9.837,95%CI:1.690~57.260,P=0.011)是PFS的独立预测因素,而MTV(HR=12.470,95%CI:3.356~46.336,P<0.001)是OS的独立预测因素。所构建的PFS预后预测模型中,低危组(n=42)与中危组(n=20)的生存曲线差异有统计学意义(χ^(2)=7.84,P=0.005),中危组与高危组(n=12)的生存曲线差异也有统计学意义(χ^(2)=18.72,P<0.001)。结论MTV和DE能够独立预测PGI-DLBCL患者的PFS,MTV能够独立预测OS。MTV联合DE构建的PFS预后预测模型能够很好地对患者进行危险度分层。Objective To explore whether baseline PET metabolic parameters combined with B-cell lymphoma-2(Bcl-2)/cellular-myelocytomatosis viral oncogene(c-Myc)dual expression(DE)can improve the prognostic stratification of patients with primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL).Methods From March 2011 to November 2019,74 patients(33 males,41 females;age:20-87 years)pathologically diagnosed with PGI-DLBCL prior to treatment in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School and the First Affiliated Hospital of Nanjing Medical University were retrospectively included.Baseline PET/CT scans were calculated automatically using the boundaries of voxels presenting a SUVmax≥2.5,and metabolic tumor volume(MTV)and total lesion glycolysis(TLG)were determined.Expressions of Bcl-2 and c-Myc were detected at protein levels by immunohistochemistry(IHC).A predicting model comprised of MTV and DE was constructed and patients were divided into 3 groups,including low-risk group(low MTV and non-DE),mediate-risk group(high MTV or DE)and high-risk group(high MTV and DE).The distributions of progression-free survival(PFS)and overall survival(OS)rates were estimated using the Kaplan-Meier method,log-rank test and Cox proportional hazards model.Results Of 74 patients,20 relapsed or progressed,13 died,and 29.7%(22/74)patients were DE positive.Multivariate analysis revealed that MTV(hazard ratio(HR)=9.110,95%CI:1.429-18.615,P=0.012)and DE(HR=9.837,95%CI:1.690-57.260,P=0.011)were independent predictors of PFS,while MTV(HR=12.470,95%CI:3.356-46.336,P<0.001)was the only independent predictor of OS.In the predicting model for PFS,low-risk group(n=42)and mediate-risk group(n=20)exhibited significant difference(χ^(2)=7.84,P=0.005),and mediate-risk group and high-risk group(n=12)also exhibited significant difference(χ^(2)=18.72,P<0.001).Conclusions MTV and DE can independently predict PFS of patients with PGI-DLBCL,and MTV can independently predict OS.The predicting model for PFS combinin

关 键 词：淋巴瘤 大B细胞 弥漫性 胃肠道 基因 BCL-2 原癌基因蛋白质C-MYC 正电子发射断层显像术 

分 类 号：R735[医药卫生—肿瘤] R730.44[医药卫生—临床医学]