基线18F-FDG PET/CT结合临床病理特征对弥漫大B细胞淋巴瘤的预后价值  

Prognostic Value of Baseline 18F-FDG PET/CT Combined with Clinicopathological Characteristics in Diffuse Large B-Cell Lymphoma

作　　者：赵彤 原凌[2] 李佳琳 赵铭[2] 林艳梅[2] 邢军[2] 保兰兰 ZHAO Tong;YUAN Ling;LI Jia-Lin;ZHAO Ming;LIN Yan-Mei;XING Jun;BAO Lan-Lan(Department of Nuclear Medicine,The Second Affiliated Hospital of Chongqing Medicial University,Chongqing 400010,China;Department of Nuclear Medicine,Cancer Hospital Affiliated to Shanxi Medical University/Shanxi Province Cancer Hospital,Taiyuan 030013,Shanxi Province,China)

机构地区：[1]重庆医科大学附属第二医院核医学科,重庆400010 [2]山西医科大学附属肿瘤医院,山西省肿瘤医院核医学科,山西太原030013

出　　处：《中国实验血液学杂志》2025年第2期365-372,共8页Journal of Experimental Hematology

基　　金：山西省“四个一批”引导性科技专项基金项目(2021XM49)。

摘　　要：目的:探讨基线18F-脱氧葡萄糖(FDG)PET/CT代谢参数结合临床病理特征对初诊弥漫大B细胞淋巴瘤的预后评估价值,分析肿瘤代谢体积(MTV)和病灶糖酵解总量(TLG)与临床病理特征的关系。方法:回顾性分析经病理证实的120例弥漫大B细胞淋巴瘤患者的资料。所有患者在治疗前1周均行18F-FDG PET/CT显像,获得SUVmax、SUVmean、肿瘤-纵隔血池标准化摄取值比(TBR)、肿瘤-肝脏标准化摄取值比(TLR)。以SUVmax 41%作为阈值,测量MTV和TLG,并分析其与临床病理特征的关系。随访6-153个月,计算无进展生存期(PFS)。应用受试者工作特征(ROC)曲线、卡方检验、Kaplan-Meier法、log-rank检验、Cox比例风险回归模型分析数据。结果:SUVmax、MTV、TLG、TBR、TLR预测肿瘤进展的最佳界值分别为22.25、256.05、5232.67、12.97、10.60,将患者按界值分别分为两组,Kaplan-Meier生存分析结果显示两组间PFS差异均有统计学意义(均P<0.05)。MTV和TLG与NCCN-IPI评分、Ann Arbor分期、血清乳酸脱氢酶水平以及C-MYC、BCL-2、BCL-6基因重排相关(均P<0.05)。单因素分析结果显示,NCCN-IPI评分>3分、C-MYC、BCL-2、BCL-6基因重排阳性、SUVmax≥22.25、MTV≥256.05 cm^(3)、TLG≥5232.67 g、TBR≥12.97均为患者预后的不良因素(HR:1.949-5.759,均P<0.05)。多因素Cox回归分析结果显示,C-MYC基因重排阳性、BCL-2基因重排阳性、TLG≥5232.67 g均是影响患者PFS的独立危险因素(HR:4.660、3.350、4.031,均P<0.05)。结论:基线18F-FDG PET/CT代谢参数SUVmax、MTV、TLG、TBR、TLR均可作为预测弥漫大B细胞淋巴瘤患者PFS的重要指标,结合临床病理特征能更好地预测患者的预后。Objective:To investigate the prognostic value of 18 F-deoxyglucose(FDG)PET/CT metabolic parameters combined with clinicopathological features for newly diagnosed diffuse large B-cell lymphoma(DLBCL)before treatment,and analyze the relationship between tumor metabolic volume(MTV),total lesion glycolysis(TLG)and clinicopathological features.Methods:The clinical data of 120 patients with pathologically confirmed DLBCL were retrospectively analyzed and 18 F-FDG PET/CT was performed 1 week before treatment.The metabolic parameters including SUVmax,SUVmean,tumor-to-blood standardized uptake value ratio(TBR),tumor-to-liver standardized uptake value ratio(TLR)were obtained.MTV and TLG of the lesions were obtained with 41%of SUVmax as the threshold,and the correlation of MTV and TLG with clinicopathological features were analyzed.Progression-free survival(PFS)was calculated by follow-up for 6-153 months.Receiver operating characteristic(ROC)curve,chi-square test,Kaplan-Meier test,log-rank test and Cox proportional hazards model were used to analyze the date.Results:The optimum cut-off values of the SUVmax,MTV,TLG,TBR and TLR for predicting tumor progression were 22.25,256.05,5232.67,12.97 and 10.60,respectively.The patients were divided into two groups according to the above cut-off values,respectively.Kaplan-Meier survival analysis showed that there were statistically significant differences in PFS between the two group(all P<0.05).The MTV and TLG values were correlated with NCCN-IPI score,Ann Arbor stage,serum lactate dehydrogenase level,and C-MYC,BCL-2,BCL-6 gene rearrangement(all P<0.05).Univariate analysis showed that NCCN-IPI score>3,C-MYC,BCL-2,BCL-6 gene rearrangement positive,SUVmax≥22.25,MTV≥256.05 cm^(3),TLG≥5232.67 g and TBR≥12.97 were adverse factors for prognosis(HR:1.949-5.759,all P<0.05).Multivariate Cox regression analysis showed that C-MYC,BCL-2 gene rearrangement positive and TLG≥5232.67 g were all independent risk factors affecting PFS(HR:4.660,3.350,4.031,all P<0.05).Conclusion:The 18 F-FDG

关 键 词：弥漫大B细胞淋巴瘤 正电子发射断层成像/计算机断层扫描 18F-脱氧葡萄糖 预后 

分 类 号：R733[医药卫生—肿瘤]