中期PET/CT在227例弥漫大B细胞淋巴瘤患者预后评估中的价值研究

Prognostic Value of Interim PET/CT in 227 Patients of DLBCL

目的:探讨中期18F-FDG PET/CT在弥漫大B细胞淋巴瘤(DLBCL)患者疗效及预后评估中的价值。方法:在病理确诊的227例DLBCL患者治疗前及化疗后第3周期前行18F-FDC PET/CT成像。通过随访,视觉分析,Deauville评分及半定量方法,最大标准摄取值减少率(△SUVmax)分析患者的疗效及无进展生存率(PFS)、总生存率(OS),并回归分析影响生存的独立危险因素。结果:中位随访时间71月。受试者工作曲线(ROC)计算△SUVmax最佳分界点为71%,Deauville评分与△SUVmax方法评估疗效敏感度、特异度及准确度分别为86.9%、74.3%、82.8%和77.8%、63.5%、73.1%。生存曲线分析显示,Deauville评分、△SUVmax及临床国际预后指数(IPI)预测PFS、OS均具有显著意义(P=0.001)。Deauville评分与IPI是影响预后的独立危险因素。结论:中期PET/CT显像对评估DLBCL患者的疗效及预后具有显著作用。

Objective: To investigate the prognostic evaluation value of fluorodeoxyglucose(FDG) interim positron emission tomography/computed tomography(PET/CT) for diffuse large B cell lymphoma(DLBCL). Methods: Two hundred and twenty-seven patients with pathologically diagnosed DLBCL underwent 18 F-FDG scans at baseline and before 3 cycles of a rituximab-containing chemotherapy regimen. The Visual Deauville score(DS) and changes in maximum standard uptake values(△SUVmax) were calculated for tracer for the predominant lesion of each patient, for prediction of progression-free survival(PFS) and overall survival(OS) using Kaplan-Meier method and COX regression.Results: The median follow-up period was 71 months. Receiver operating characteristic analysis indicated that the best△ SUV cut-off values for FDG(△SUVFDG) was 71%. The sensitivity, specificity and accuracy of DS and △SUVmax were 86.9%, 74.3%, 82.8% and 77.8%, 63.5%, 73.1%, respectively in response assessment. Kaplan-Meier analysis showed DS, △SUVmax and IPI had significance for prediction of PFS and OS(P = 0.001). The DS 4-5 and IPI 3-5 were independent risk factors of poor prognosis by COX regression analysis. Conclusion: Interim PET/CT is important predictor for evaluation therapeutic response and prognosis in DLBCL patients.