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目的 :探讨初诊弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者治疗中期18氟-氟代脱氧葡萄糖-PET/CT(18F-fluoro-2-deoxy-D-glucose-PET/CT,18F-FDG-PET/CT)的预后判断价值。方法 :回顾性分析69例初诊DLBCL患者的临床资料。所有患者均接受R-CHOP/CHOP方案一线治疗,且化疗前及化疗3个疗程后均接受PET/CT检查(分别命名为PET0和PET3),计算肿瘤病灶的最大标准化摄取值(maximum standardized uptake value,SUVmax)。应用受试者工作特征曲线确定PET0至PET3的SUVmax下降指数[ΔSUVmax(PET0-3)]的最佳分界值。Pearsonχ2检验、Kaplan Meier法及COX比例风险模型评价ΔSUVmax(PET0-3)与治疗前临床特征及疗效的关系,以及对无进展生存(progression-free survival,PFS)和总生存(overall survival,OS)的判断价值。结果:ΔSUVmax(PET0-3)预测DLBCL患者疾病进展的最佳分界点为80%。ΔSUVmax(PET0-3)与血清乳酸脱氢酶水平、Ann Arbor分期和国际预后指数密切相关。ΔSUVmax(PET0-3)≥80%组的完全缓解率及总有效率均显著高于<80%组;ΔSUVmax(PET0-3)≥80%组的3年PFS率及OS率均显著优于<80%组(3年PFS率:86.5%vs 44.1%,P=0.000;3年OS率:95.2%vs 68.6%,P=0.004)。多因素生存分析结果显示,ΔSUVmax(PET0-3)<80%是影响患者PFS和OS的独立预后因素(PFS:P=0.000,风险比为8.301;OS:P=0.016,风险比为7.191)。结论:接受R-CHOP/CHOP方案治疗的初诊DLBCL患者,以ΔSUVmax PET0-3)作为评判标准的治疗中期PET/CT是预测PFS和OS的重要因素,对患者的危险度分层具有重要的临床价值。
Objective: To investigate the clinical effect of 18F-fluoro-2-deoxy-D-glucose-PET / CT in patients with newly diagnosed diffuse large B-cell lymphoma , 18F-FDG-PET / CT) prognostic value. Methods: The clinical data of 69 newly diagnosed DLBCL patients were retrospectively analyzed. All patients received first-line R-CHOP / CHOP regimen and PET / CT examinations (PET0 and PET3 respectively) before and 3 cycles after chemotherapy were performed to calculate the maximum standardized uptake value , SUVmax). The receiver operating characteristic curve was used to determine the optimal cutoff for the SUVmax descent index [ΔSUVmax (PET0-3)] for PET0 to PET3. Pearsonχ2 test, Kaplan Meier method and COX proportional hazard model were used to evaluate the relationship between the clinical features and therapeutic effect of ΔSUVmax (PET0-3), the progression-free survival (PFS) and overall survival (OS) Judgment value. RESULTS: The optimal cutoff point for ΔSUVmax (PET0-3) prediction of disease progression in DLBCL patients was 80%. ΔSUVmax (PET0-3) is closely related to serum lactate dehydrogenase level, Ann Arbor stage and International Prognostic Index. The complete remission rate and total effective rate of group with ΔSUVmax (PET0-3) ≥80% were significantly higher than <80% group. The three-year PFS rate and OS rate of group with ΔSUVmax (PET0-3) ≥80% 80% group (3-year PFS rate: 86.5% vs 44.1%, P = 0.000; 3-year OS rate: 95.2% vs 68.6%, P = 0.004). Multivariate survival analysis showed that ΔSUVmax (PET0-3) <80% was an independent prognostic factor for PFS and OS in patients (PFS: P = 0.000; hazard ratio: 8.301; OS: P = 0.016; risk ratio: 7.191). CONCLUSIONS: The newly diagnosed DLBCL patients treated with R-CHOP / CHOP regimen, and ΔSUVmax PET0-3 as the criteria for evaluation, are important predictors of PFS and OS, and have important clinical implications for stratification of patients value.