化疗中期^(18)F-FDG PET/CT对Ⅲ/Ⅳ期结外弥漫大B细胞淋巴瘤疗效和预后的预测价值  

Predictive value of interim^(18)F-FDG PET/CT in the efficacy and prognosis of patients with stageⅢ/Ⅳextranodal diffuse large B-cell lymphoma

作　　者：李旭[1] 刘甫庚[1] 宋书扬 陈聪霞[1] 颜东岳 姚稚明[1] Li Xu;Liu Fugeng;Song Shuyang;Chen Congxia;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 Nuclear Medicine,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,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]北京协和医学院,国家心血管病中心,中国医学科学院阜外医院核医学科,北京100037

出　　处：《国际放射医学核医学杂志》2024年第3期149-158,共10页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的分析化疗中期^(18)F-氟脱氧葡萄糖(FDG)PET/CT(iPET/CT)的4种评价指标对Ⅲ/Ⅳ期结外弥漫大B细胞淋巴瘤(EN-DLBCL)患者初始化疗疗效和预后的预测价值。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Ⅲ/Ⅳ期(Ann Arbor分期)EN-DLBCL的56例初诊患者的影像资料和临床资料,其中男性27例、女性29例,中位年龄为68.5岁,年龄范围为27~88岁。通过医院电子病历系统或电话进行随访。采用受试者工作特征(ROC)曲线确定iPET/CT的最大标准化摄取值(iSUVmax)、治疗前后SUVmax的减少率(ΔSUVmax%)以及中期病灶与肝脏SUVmax的比值(iLLR)的最佳临界值,分别以最佳临界值和Deauville五分法评分(DS)对患者分组。分析iPET/CT指标对Ⅲ/Ⅳ期EN-DLBCL患者初始化疗的疗效和预后的预测价值。计数资料的比较采用χ2检验;采用Kaplan-Meier法和Log-rank检验分析患者2年无进展生存(PFS)率、总生存(OS)率和组间差异;采用单因素、多因素Cox比例风险回归分析iSUVmax、ΔSUVmax%、iLLR、DS对Ⅲ/Ⅳ期EN-DLBCL患者初始化疗的疗效和预后的预测价值。结果初始化疗结束时,完全缓解(CR)患者31例(55.4%)。iSUVmax<4.9组、ΔSUVmax%≥87.0%组、iLLR<1.31组、DS 1~3分组患者初始化疗结束时的CR率分别为74.2%(23/31)、76.2%(16/21)、67.6%(23/34)、76.0%(19/25),明显高于iSUVmax≥4.9组、ΔSUVmax%<87.0%组、iLLR≥1.31组、DS 4~5分组患者[32.0%(8/25)、42.9%(15/35)、36.4%(8/22)、38.7%(12/31)],且差异均有统计学意义(χ2=9.970、5.901、5.290、7.787,均P<0.05)。中位随访时间22个月,随访时间范围为4~103个月,随访结束时,19例患者(33.9%)进展、复发或死亡。iSUVmax<4.9组、iLLR<1.63组、DS 1~3分组患者的2年PFS率(83.9%、83.7%、84.0%)均明显高于iSUVmax≥4.9组、iLLR≥1.63组、DS 4~5分组患者(50.4%、37.6%、57.5%),差异均有统计学意义(χ2=6.117、10.478、4.116,均P<0.05);iLLR<1.63组患者的2Objective To analysis the value of four evaluation indicators based on interim^(18)F-fluorodeoxyglucose(FDG)PET/CT(iPET/CT)in predicting the response to primary chemotherapy and prognosis of patients with stageⅢ/Ⅳextranodal diffuse large B-cell lymphoma(EN-DLBCL).Methods A retrospective analysis was conducted on the imaging and clinical data of 56 newly diagnosed patients(27 males and 29 females;aged 27−28 years old with a median age of 68.5)with stageⅢ/ⅣEN-DLBCL confirmed by histopathological examination or follow-up in Beijing Hospital from May 2011 to April 2020.Follow-up was performed through the hospital's electronic medical record system or phone call.The receiver operating characteristic(ROC)curve was used to select the optimal cut-off for the maximum standardized uptake value of iPET/CT lesions(iSUVmax),the reduction percentage of lesions'SUVmax on interim and baseline PET/CT(ΔSUVmax%),and the ratio of lesions'SUVmax to liver SUVmax(iLLR).Patients divided into groups using the optimal cutoff and the interim Deauville 5-point scale(DS).The predictive value of iPET/CT indicators on the efficacy and prognosis of primary chemotherapy in patients with stageⅢ/ⅣEN-DLBCL was analyzed.χ2 test was employed to compare the count data.Kaplan-Meier method and Log-rank test were applied to analyze the patients'2-year progression-free survival(PFS)rates,overall survival(OS)rates,and differences between groups.Univariate and multivariate Cox proportional risk regression analysis were utilized to analyze the predictive value of iSUVmax,ΔSUVmax%,iLLR,and DS for the efficacy and prognosis of primary chemotherapy in patients with stageⅢ/ⅣEN-DLBCL.Results At the end of primary chemotherapy,31 patients(55.4%)achieved complete remission(CR).The CR rates in the iSUVmax<4.9,ΔSUVmax%≥87.0%,iLLR<1.31,and DS 1−3 groups were higher than those in the iSUVmax≥4.9,ΔSUVmax%<87.0%,iLLR≥1.31,and DS 4−5 groups(74.2%(23/31)vs.32.0%(8/25),76.2%(16/21)vs.42.9%(15/35),67.6%(23/34)vs.36.4%(8/22),and 76.0%(19/25)vs

关 键 词：淋巴瘤 大B细胞 结外 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 最大标准化摄取值 预后 Deauville五分法 疗效 

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