^18氟代脱氧葡萄糖正电子发射断层成像/计算机断层扫描在弥漫性大B细胞淋巴瘤中的应用价值

The value of ^18F-fluorodeoxyglucose positron emission tomography/computed tomography in diffuse large B-cell lymphoma

目的探讨^18氟代脱氧葡萄糖(18F-FDG)正电子发射断层成像(PET)/计算机断层扫描(CT)在弥漫性大B细胞淋巴瘤(DLBCL)中的应用价值,并对患者的预后情况进行分析。方法选取接受R-CHOP方案化疗的78例DLBCL患者。记录18F-FDG PET/CT的初始(化疗前)参数和中期(化疗3~4个疗程)参数,观察DLBCL患者的临床特征与预后不良的关系及初始、中期参数对预后的评估效能,并对患者的生存情况及预后影响因素进行分析。结果年龄、是否合并B症状、Ann Arbor分期为Ⅲ期及以上、是否合并结外病变、预后指数可能与DLBCL患者的预后不良有关(P<0.05);性别可能与DLBCL患者的预后不良无关(P>0.05)。单因素分析结果显示,年龄、是否合并B症状、预后指数、MTV-o>截断值、MTV-m>截断值、TLG-o>截断值、TLG-m>截断值均可能与DLBCL患者的远期预后有关(P<0.05)。生存分析结果显示,低MTV-o、低MTV-m患者的2年PFS率均高于高MTV-o、高MTV-m患者,低TLG-o、低TLG-m患者的2年PFS率均高于高TLG-o、高TLG-m患者(P<0.05)。细化研究结果显示,高MTV-o组中,低MTV-m的患者的PFS率明显高于高MTV-m患者(P<0.01);高TLG-o组中,低TLG-m的患者的PFS率高于高TLG-m患者(P<0.05)。结论相较于单纯检测初始参数,合理利用MTV-m、TLG-m等中期参数有利于较好地反映DLBCL的显像特点,科学监测DLBCL对于化疗的反应性,进而准确、高效地评估患者的远期预后情况,值得临床推广。

Objective To analyze the value of ^18F-fluorodeoxyglucose-positron emission tomography/computed tomography(^18F-FDG PET/CT)in diffuse large B-cell lymphoma(DLBCL),and to evaluate the prognosis of patients.Method Totally,78 patients with DLBCL receiving R-CHOP regimen were included in the analysis.The initial(pre-chemotherapy)and mid-term(3-4 cycles during chemotherapy)parameters of ^18F-FDG PET/CT were recorded,the relationship between clinical characteristics of DLBCL patients and poor prognosis was analyzed,and the efficacy of initial and midterm parameters in evaluating prognosis was determined,additionally,the survival and prognostic factors were assessed.Result Age,comorbidity of B symptoms,Ann Arbor stage forⅢand above,presence of extranodal lesions,and prognostic index were likely associated with the prognosis of DLBCL patients(P<0.05);while gender might not be involved with poor prognosis of DLBCL patients(P>0.05).Univariate analysis revealed that,age,presence of B symptoms,prognostic index,MTV-o>cut-off value,MTV-m>cut-off value,TLG-o>cut-off value,TLG-m>cut-off value were possibly associated with DLBCL patients’long-term prognosis(P<0.05).Survival analysis showed that,low MTV-o and low MTV-m were related to higher 2-year PFS rate compared to high MTV-o,high MTV-m,besides,low TLG-o and low TLG-m were also linked to a reduced 2-year PFS rate compared to high TLG-o and high TLG-M(P<0.05).Further subgroup analysis revealed that,in high MTV-o group,patients with low MTV-m were with evidently higher PFS rate than in those with high MTV-m(P<0.01);in high TLG-o group,better PFS rate was observed in patients with low TLG-m compared to high TLG-m(P<0.05).Conclusion Compared with the simple detection of initial parameters,the reasonable use of MTV-m,TLG-m and other mid-term parameters is conducive to better reflecting the imaging characteristics of DLBCL,scientific monitoring of DLBCL response to chemotherapy,and then accurately and efficiently evaluate the long-term prognosis.