PET—CT预测弥漫大B细胞淋巴瘤患者预后的价值

Prognostic value of PET-CT in patients with diffuse large B-cell lymphoma

目的探讨化疗中期和终末期行PET—CT检查预测弥漫大B细胞淋巴瘤（DLBCL）患者预后的价值。方法回顾性分析116例DLBCL患者的^18F—FDG PET-CT显像资料，其中43例患者在化疗中期（4个周期）、48例患者在化疗终末期（6～8个周期）、25例患者在化疗中期和终末期均行PET—CT检查。通过与治疗前PET-CT的结果进行比较，将患者分为完全缓解组、部分缓解组和无缓解组，对各组患者的预后进行比较。结果中期组患者中，完全缓解42例，部分缓解15例，无缓解11例，完全缓解、部分缓解和无缓解患者的2年无进展生存率分别为61．9％、60．0％和18．2％，3年总生存率分别为52．4％、46．7％和9．1％。完全缓解与部分缓解患者的2年无进展生存率和3年总生存率差异均无统计学意义（均P〉0．05），部分缓解与无缓解患者的2年无进展生存率和3年总生存率差异均有统计学意义（均P〈0．05）。终末期组患者中，完全缓解50例，部分缓解11例，无缓解12例，完全缓解、部分缓解和无缓解患者的2年无进展生存率分别为82．0％、45．5％和8．3％。3年总生存率分别为88．0％、54．5％和8．3％。完全缓解与部分缓解患者的2年无进展生存率和3年总生存率差异均有统计学意义（均P〈0．05），部分缓解与无缓解患者的2年无进展生存率和3年总生存率差异也有统计学意义（均P〈0．05）。结论与中期行PET-CT比较，终末期行PET—CT更能准确地评估DLBCL患者的预后；中期行PET—CT不能区分完全缓解与部分缓解DLBCL患者的预后。

Objective To investigate the prognostic value of interim and post-therapy PET-CT in patients with diffuse large B-cell lymphoma. Methods A retrospective analysis was conducted on data from 116 patients with newly diagnosed diffuse large B-cell lymphoma. 43 patients underwent interim PET-CT after 4 cycles of chemotherapy, 48 patients underwent post-therapy PET-CT after 6-8 cycles of chemotherapy, and 25 patients underwent both interim PET-CT and post-therapy PET-CT. The patients were divided into three groups： complete response group, partial response group and no response group. The therapeutic response was assessed by comparing with baseline PET-CT. PET-CT status was assessed for its ability to predict progression-free survival （PFS） and overall survival （OS）. The 2-year PFS rate and 3-year OS rate were evaluated using chi-square test. PFS and OS were estimated according to the Kaplan-Meier method and survival curves were compared by log-rank test. Results Interim PET-CT： The interim PET-CT findings of 42 patients were judged as complete response, 15 were judged as partial response, and the rest 11 were judged as no response. The 2-year PFS rates of the complete response group, partial response group and no response group were 61.9%, 60.0% , and 18.2%, respectively, and the 3-year OS rates were 52.4%, 46.7% and 9.1% , respectively. There were no significant differences between the complete response group and partial response group in 2-year PFS rate and 3-year OS rate （ P 〉0.05 for both）. But there was a significant difference between the partial response group and no response group （ P 〈 0.05 ）. The post-therapy PET-CT findings of 50 patients was judged as complete response, 11 as partial response, and the rest 12 were judged as no response. The 2-year PFS rate of the complete response group, partial response group and no response group were 82.0%, 45.5%, and 8.3%, respectively, and the 3-year OS rates were 88.0%, 54.5%, and 8.3%, respectively. There were significant differences between the complete response group and partial response group in 2-year PFS rate and 3-year OS rate （ P 〈 0.05 ） , and there was a significant difference between the partial response group and no response group （ P 〈 0.05 ）. Conclusions Compared with the interim PET-CT, post-therapy PET-CT can accurately evaluate the prognosis of patients with DLBCL. Interim PET-CT cannot define the prognosis of the complete response and partial response patients.