c⁃myc基因重排与弥漫大B细胞淋巴瘤患者临床特征、PET⁃CT影像特征及预后的关系  

Relationship between c-myc gene rearrangement and clinical characteristics,PET-CT imaging features and prognosis of patients with diffuse large B-cell lymphoma

作　　者：张晓娟[1] 李佳琳 赵彤 原凌[2] Zhang Xiaojuan;Li Jialin;Zhao Tong;Yuan Ling(Department of Medical Imaging,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Nuclear Medicine PET/CT Center,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to 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医学影像科,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核医学PET/CT中心,太原030013

出　　处：《肿瘤研究与临床》2025年第3期190-197,共8页Cancer Research and Clinic

基　　金：山西省自然科学基金(202203021211046);山西省“四个一批”重点科技基金(2021XM49);国家肿瘤区域医疗中心科教培育基金(SD2023025)。

摘　　要：目的探讨弥漫大B细胞淋巴瘤(DLBCL)c⁃myc基因重排与患者临床特征、18F⁃脱氧葡萄糖(FDG)PET⁃CT影像特征及预后的相关性。方法回顾性队列研究。选择2010年9月至2022年12月在山西省肿瘤医院初诊的152例治疗前1周行18F⁃FDG PET⁃CT检查的病理证实为DLBCL的患者,收集患者临床资料及PET⁃CT影像数据。采用荧光原位杂交(FISH)法检测肿瘤组织c⁃myc基因重排。比较是否伴c⁃myc基因重排患者间临床特征及PET⁃CT影像特征。采用Kaplan⁃Meier法绘制患者无进展生存(PFS)和总生存(OS)曲线,组间比较采用log⁃rank检验。采用单因素和多因素Cox比例风险模型分析影响DLBCL患者预后的因素。结果152例患者中,男性85例(55.9%),女性67例(44.1%);年龄(58±15)岁,范围25~81岁;22例(14.5%)伴c⁃myc基因重排(其中双打击7例),其余130例(85.5%)未伴c⁃myc基因重排。是否伴c⁃myc基因重排患者间治疗方案、美国国立综合癌症网络国际预后指数(NCCN⁃IPI)评分、乳酸脱氢酶(LDH)水平是否增高、bcl⁃6蛋白是否阳性患者构成及18F⁃FDG PET⁃CT参数肿瘤代谢体积(MTV)是否≥256.04 cm3、糖酵解总量(TLG)是否≥2292.34 g患者构成差异均有统计学意义(均P<0.05);性别、年龄、肿瘤累及范围、Ann Arbor分期、免疫分型、骨髓侵犯、乙型肝炎病毒感染、CD10蛋白、MUM1蛋白、bcl⁃2蛋白不同状态患者构成及18F⁃FDG PET⁃CT其他影像参数分层患者构成差异均无统计学意义(均P>0.05)。伴c⁃myc基因重排者MTV[(727±268)cm3比(314±33)cm3]和TLG[(8965±1868)g比(5341±627)g]均高于未伴c⁃myc基因重排者,差异均有统计学意义(t值分别为3.07、2.19,P值分别为0.003、0.035);是否伴c⁃myc基因重排者间最大标准化摄取值、平均标准化摄取值、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差异均无统计学意义(均P>0.05)。中位随访79.5个月,范围6~153个月。伴c⁃Objective To investigate the correlation between c-myc gene rearrangement and clinical characteristics,18F-deoxyglucose(FDG)PET-CT imaging features and prognosis of patients with diffuse large B-cell lymphoma(DLBCL).Methods A retrospective cohort study was conducted.A total of 152 patients with DLBCL confirmed by pathology and underwent 18F-FDG PET-CT examination one week before treatment at Shanxi Province Cancer Hospital from September 2010 to December 2022 were selected,and their clinical data and PET-CT imaging data were collected.Fluorescence in situ hybridization(FISH)method was used to detect c-myc gene rearrangement in tumor tissues.The clinical characteristics and PET-CT imaging features between patients with and without c-myc gene rearrangement were compared.Kaplan-Meier method was used to plot the progression-free survival(PFS)and overall survival(OS)curves of patients,and log-rank test was used for inter group comparison.Univariate and multivariate Cox proportional hazards models were used to analyze the factors affecting the prognosis of DLBCL patients.Results Among the 152 patients,there were 85 males(55.9%)and 67 females(44.1%);the age was(58±15)years old(range:25-81 years old);22 cases(14.5%)had c-myc gene rearrangement(including 7 cases of double hit),while the remaining 130 cases(85.5%)did not have c-myc gene rearrangement.There were statistically significant differences in the compositions of patients with different treatment plans,National Comprehensive Cancer Network International Prognostic Index(NCCN-IPI)scores,elevated lactate dehydrogenase(LDH)levels,positive bcl-6 protein,18F-FDG PET-CT parameters,metabolic tumor volume(MTV)≥256.04 cm3,total lesion glycolysis(TLG)≥2292.34 g between patients with and without c-myc gene rearrangement(all P<0.05);there were no statistically significant differences in the compositions of patients with different genders,age,tumor involvement range,Ann Arbor staging,immunophenotyping,bone marrow invasion,hepatitis B virus infection,CD10 protein,MUM1 prote

关 键 词：淋巴瘤 大B细胞 弥漫性 基因 myc 基因重排 正电子发射断层显像术 体层摄影术 X线计算机 预后 

分 类 号：R733.1[医药卫生—肿瘤]