非霍奇金淋巴瘤治疗前PET/CT中SUV的相关因素研究

CORRELATION ANALYSIS OF THE SUV VALUE IN PRE-THERAPY FDG-PET/CT IN PATIENTS WITH NON-HODGKIN LYMPHOMA

目的探讨非霍奇金淋巴瘤(NHL)在18F-FDG PET/CT检查中标准化摄取值(SUV)的影响因素及与预后的关系。方法分析136例NHL患者全身最大淋巴结的SUVmax与其年龄、B症状、恶性程度、骨髓浸润、临床分期、病灶大小、坏死情况、治疗前血清LDH(psLDH)及Ki-67阳性率的关系及部分因素之间的相关性。采用Wilcoxon检验分析SUVmax与临床病理特征间的关系;采用Spearman秩相关分析SUVmax与病灶大小、Ki-67阳性率及psLDH的相关性。随访71例患者,根据R-IPI将71例患者分为预后非常好、预后好、预后差三组,采用方差分析分析SUVmax与临床预后的关系。结果经Wilcoxon检验发现SUVmax与恶性程度(P=0.0003)、骨髓浸润(P=0.003)、临床分期(P=0.021)、病灶大小(P=0.0001)、坏死情况(P=0.011)、psLDH(P=0.0002)、Ki-67阳性率(P=0.015)有关。经Spearman秩相关分析发现SUVmax与病灶大小、Ki-67阳性率及psLDH呈正相关,相关系数r分别为0.737、0.615、0.691(P<0.05)。通过ROC曲线比较,结果提示SUVmax、psLDH能够较准确地反映NHL的侵袭性,AZ值分别为0.878、0.740。经方差分析发现随访预后3组患者病灶的SUVmax有差异,分别为6.87±2.79、9.69±2.19、18.65±5.95,呈逐渐升高趋势,预后非常好与预后好组的SUVmax明显低于预后差组(P<0.05)。结论 SUVmax与多项临床病理指标有关系,且与病灶大小、Ki-67阳性率及psLDH呈正相关,其中病灶大小对SUVmax影响最明显。另外SUVmax较psLDH诊断侵袭性淋巴瘤的准确性略高。在R-IPI的不同随访预后组中病灶的SUVmax有差异,呈逐渐升高趋势。

Objective To explore the related factors of PET/CT standardized uptake value（SUV）in patients with Non-Hodgkin lymphoma（NHL）.Methods Clinical and pathological data of the 136 patients were retrospectively analyzed.Relationships of SUV max in cervical lymph nodes with age,B group,grade malignancy,bone marrow involvement,tumor staging,lesion size,necrosis,pre-treatment serum LDH（psLDH）and positive rate of Ki-67 were observed.Wilcoxon test was used for the clinical characteristics between the two groups.The correlations of SUV max with tumor size,positive rate of Ki-67 and psLDH were analyzed by using Spearman rank correlation.Seventy one patients were followed up according to RIPI,and divided into 3 prognostic groups（very good,good,poor）,variance analysis was used to analyze the relation between SUVmax and the prognosis of the disease.Results There were relationships of SUV max with grade malignancy（P=0.0003）,bone marrow involvement（P=0.003）,tumor staging（P=0.021）,lesion size（P=0.0001）,necrosis（P=0.011）,psLDH（P=0.0002）and positive rate of Ki-67（P=0.015）.The relationships of SUV max with the lesion size,positive rate of Ki-67 and psLDH were positively correlated（r=0.737,0.615 and 0.691 respectively）.A receiver operating characteristic（ROC）analysis demonstrated that the SUV max and psLDH distinguished reasonably well between aggressive and indolent disease（area under ROC curve,0.878 and 0.740 respectively）.The variance analysis showed that the PET/CT treatment for 3 groups of SUV max were different,6.87±2.79,9.69±2.19,18.65±5.95,respectively,increasing with poor prognosis group.SUV max was significantly higher than the excellent prognosis with good prognosis group,and the results were statistically significant（P〈0.05）.Conclusion SUV max is associated with several clinical pathological data.And SUV max with the lesion size,positive rate of Ki-67 and psLDH are positively correlated,the lesion size has most significant value in the levels of SUV max.SUV max is higher than psLDH in the diagnosis accuracy of aggressive lymphoma.The SUV max in different prognosis groups before treatment presents a gradually increasing tendency.