弥漫大B细胞淋巴瘤化疗中后期用^(18)F-FDGPET/CT显像预测预后是否优于化疗中期?

^(18)F- FDG PET/CT for predicting outcomes of diffuse large B- cell lymphoma: shall it be performed in the interim versus later phase of chemotherapy?

目的探讨弥漫大B细胞淋巴瘤(DLBCL)患者在化疗中期和中后期进行18F-FDG PET/CT显像判断预后的价值差异。方法DLBCL初诊患者142例,于标准化疗第3~4个疗程结束进行首次18F-FDG PET/CT评价为化疗中期组,于标准化疗5~8个疗程结束进行首次PET/CT评价者为化疗中后期组,两组各有71例,首次PET/CT显像结果记录为阴性和阳性。所有患者随访18~114个月(平均28.73个月),根据随访结果计算无进展生存时间(PFS)和无进展生存率(PFS%),比较化疗中期组与中后期组患者首次18F-FDG PET/CT显像结果与预后的关系。结果化疗中期组18F-FDG PET/CT显像阴性和阳性率分别为63.4%、36.6%,化疗中后期组PET/CT显像阴性和阳性率分别为66.2%、33.8%,两组PET/CT显像阴性率及阳性率无明显差异(χ2=12.423,P>0.05)。PFS比较,化疗中期组首次18F-FDG PET/CT显像阴性和阳性者PFS分别为63.56和19.23个月(P=0.000),化疗中后期组首次PET/CT显像阴性和阳性者的PFS分别为65.78和24.32个月(P=0.000)。化疗中期组和中后期组首次PET/CT显像阴性者PFS时间无显著性差异(63.56 vs 65.78个月,P=0.613);化疗中期组和中后期组首次PET/CT显像阳性者PFS时间也无显著性差异(19.23 vs 24.32个月,P=0.274)。PFS率比较,化疗中期组首次PET/CT显像阴性和阳性者PFS率分别为73.3%、15.4%(χ2=12.423,P=0.000);化疗中后期组首次PET/CT显像阴性和阳性者PFS率分别为74.5%、16.7%(χ2=12.423,P=0.000)。化疗中期组和中后期组首次PET/CT显像阴性者的PFS率无明显统计学差异(73.3%vs74.5%,P=0.613);化疗中期和中后期组首次PET/CT显像阳性者的PFS率也无显著统计学差异(15.4%vs 16.7%,P=0.274)。结论 DLBCL在化疗中期和化疗中后期进行18F-FDG PET/CT显像均可较好地判断预后,在化疗中后期行PET/CT显像判断预后并不优于化疗中期,因此在化疗中期行18F-FDG PET/CT进行预测预后是合适的,不必延后到化疗中后期。

Objective To compare the value of18F- FDG PET/CT performed in the interim and later phase of chemotherapy in predicting the prognosis of diffuse large B- cell lymphoma（DLBCL）. Methods18F- FDG PET/CT was performed in 71 patients with DLBCL in the interim phase of chemotherapy（3-4 cycles） and in another 71 patients in the later phase of chemotherapy（5-8 cycles）. The patients were followed up for an average of 28.73 months（18- 114 months） to compare the progression- free survival（PFS） and the PFS rate. Results The positive finding rate was similar between18F- FDG PET/CT performed in the interim and the later phase（36.6% vs 33.8%, χ2 =12.423, P〈0.05）. The PFS was much longer in patients with negative findings than in those with positive findings in both the interim（63.56 vs 19.23 months, P=0.000） and later phase groups（65.78 vs 24.32 months, P=0.000）, but showed no significant difference between the negative patients（P〈0.05） or between the positive patients（P〉0.05） in the two groups. The PFS rate was significantly greater in patients with negative than those with positive findings in the interim group（73.3% vs 15.4%, P=0.000） and in the later phase group（74.5% vs 16.7%, P=0.000）, but comparable between the negative（P〉0.05） and between the positive patients（P〉0.05） in the two groups. Conclusions18F-FDG PET/CT in the interim and later phase of chemotherapy has similar value for predicting the prognosis of DLBCL, and we therefore recommend that18F-FDG PET/CT be performed in the interim but not in the later phase.