弥漫大B细胞淋巴瘤患者治疗前FDG-PET/CT检查与预后的相关性分析

Correlation analysis of pre-therapy FDG-PET/CT with prognosis in patients with diffuse large B-cell lymphoma

目的:评估治疗前18氟-氟代脱氧葡萄糖-正电子发射计算机断层显像(18F-FDG-PET)/CT的最大标化摄取值(SUVmax)对弥漫大B细胞淋巴瘤(DLBCL)预后预测价值。方法:回顾分析76例新发DLBCL患者初次PET/CT检查中最大SUVmax与疾病分期、乳酸脱氢酶(LDH)、校正国际预后指数(R-IPI)等预后因素之间的相关性以及预后分析。结果:初发DLBL患者PET/CT的SUVmax与疾病分期、B症状、LDH、β2微球蛋白(β2-MG)、美国东部肿瘤协作组(ECOG)评分呈正相关。R-IPI3个预后组中的SUVmax有显著区别,R-IPI预后差的一组SUVmax均值明显高于前2组,有统计学意义(P<0.001)。SUVmax=10.25预测疾病进展的灵敏度和特异度分别是84.4%和68.2%。以此为标准分2组,SUVmax<10与SUVmax≥10组总有效率分别为87.9%和55.8%(P<0.05),3年PFS率分别是86.4%±6.4%和45.9%±9.8%(P=0.004),3年总生存(OS)率无统计学差异。经多因素Cox回归分析后显示IPI、LDH和SUVmax均为独立预后因素。结论:DLBCL患者治疗前PET/CT中FDG摄取强度可以预测患者的生存情况,SUVmax越低患者预后越好,反之,SUVmax越高患者预后越差。

Objective To assess the predictive value of pre-therapy 18fluoro-deoxyglucose positron emission tomography（18F-FDG-PET）/CT maximum standard uptake value（SUVmax） on prognosis in patients with diffuse large B-cell lymphoma（DLBCL）.Methods The correlation between SUVmax of FDG-PET/CT and prognostic factors such as stage of disease,lactate dehydrogenase（LDH） level,revised international prognosis index（R-IPI） and the actual prognosis in 76 newly diagnosed DLBCL patients was analyzed retrospectively.Results FDG-PET/CT SUVmax was positive correlated with stage of disease,B symptom,LDH,β2 microglobulin（β2-MG） and East Cooperative Oncology Group（ECOG） score.Of the three R-IPI prognosis groups,SUVmax value of the poor prognosis group was significantly higher than the other two groups（P0.001）.Taking SUVmax value 10.25 as the prognosis predictive threshold,the sensitivity and specificity were 86.4%±6.4% and 45.9%±9.8%（P0.001）.Taking this as the cut-off value,the overall response rates in SUVmax10 group and SUVmax≥10 group were 87.9% and 55.8%,respectively;and the 3-year progress free survival（PFS） rates were 86.4%±6.4% and 45.9%±9.8%,respectively（P=0.004）.However,no statistical significant difference was seen in 3-year overall survival（OS） rate.Multivariate Cox regress analysis showed IPI,LDH and SUVmax were independent prognostic factors.Conclusions Pre-therapy FDG-PET/CT SUVmax could predict the prognosis and survival of patients with DLBCL.The lower the SUVmax value,the better was the prognosis of patient.