治疗中期^(18)F-FDG PET/CT与初诊弥漫大B细胞淋巴瘤患者疗效及预后的相关性

Prognostic value of interim ^(18)F-PET/CT in patients with newly diagnosed diffuse large B-cell lymphoma

目的 :探讨初诊弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者治疗中期18氟-氟代脱氧葡萄糖-PET/CT(18F-fluoro-2-deoxy-D-glucose-PET/CT,18F-FDG-PET/CT)的预后判断价值。方法 :回顾性分析69例初诊DLBCL患者的临床资料。所有患者均接受R-CHOP/CHOP方案一线治疗,且化疗前及化疗3个疗程后均接受PET/CT检查(分别命名为PET0和PET3),计算肿瘤病灶的最大标准化摄取值(maximum standardized uptake value,SUVmax)。应用受试者工作特征曲线确定PET0至PET3的SUVmax下降指数[ΔSUVmax(PET0-3)]的最佳分界值。Pearsonχ2检验、Kaplan Meier法及COX比例风险模型评价ΔSUVmax(PET0-3)与治疗前临床特征及疗效的关系,以及对无进展生存(progression-free survival,PFS)和总生存(overall survival,OS)的判断价值。结果:ΔSUVmax(PET0-3)预测DLBCL患者疾病进展的最佳分界点为80%。ΔSUVmax(PET0-3)与血清乳酸脱氢酶水平、Ann Arbor分期和国际预后指数密切相关。ΔSUVmax(PET0-3)≥80%组的完全缓解率及总有效率均显著高于<80%组;ΔSUVmax(PET0-3)≥80%组的3年PFS率及OS率均显著优于<80%组(3年PFS率:86.5%vs 44.1%,P=0.000;3年OS率:95.2%vs 68.6%,P=0.004)。多因素生存分析结果显示,ΔSUVmax(PET0-3)<80%是影响患者PFS和OS的独立预后因素(PFS:P=0.000,风险比为8.301;OS:P=0.016,风险比为7.191)。结论:接受R-CHOP/CHOP方案治疗的初诊DLBCL患者,以ΔSUVmax PET0-3)作为评判标准的治疗中期PET/CT是预测PFS和OS的重要因素,对患者的危险度分层具有重要的临床价值。

Objective： The aim of this study is to determine the prognostic value of interim 18F-FDG-PET/CT in patients with newly diagnosed diffuse large B-cell lymphoma（DLBCL）.Methods： The data of 69 patients with newly diagnosed DLBCL treated with R-CHOP or CHOP regimen were retrospectively analyzed. All patients had a PET/CT scan at diagnosis（PET0） and an interim PET/CT after the third cycle of chemotherapy（PET3）. The receiver operating characteristic（ROC） curve was used to determine the optimal cut-off value of Δmaximum standardized uptake value（SUVmax）（PET0-3）. Pearson chi-square test, Kaplan–Meier method and COX proportional hazard model were performed to analyze the correlation of ΔSUVmax（PET0-3） with pretreatment clinical factors and its prognostic value in predicting efficacy, progression-free survival（PFS） and overall survival（OS）.Results： The optimal cut-off value of ΔSUVmax（PET0-3） to predict disease progression in DLBCL patients was 80%. ΔSUVmax（PET0-3） between groups significantly differed with respect to serum lactate dehydrogenase（LDH）, Ann Arbor stage and International Prognostic Index. Complete response rate and overall response rate were differed significantly between the ΔSUVmax（PET0-3） ≥ 80% and 80% groups. ΔSUVmax（PET0-3） analysis（≥ 80% vs 80%） identified patients with significantly different survival（3-year PFS： 86.5% vs 44.1%, P = 0.000; 3-year OS： 95.2% vs 68.6%, P = 0.004）. Multivariate analysis revealed that ΔSUVmax（PET0-3） 80% independently predicted PFS and OS（PFS： P = 0.000, hazard ratio： 8.301; OS： P = 0.016, hazard ratio： 7.191）.Conclusion： Interim PET/CT using a ΔSUVmax-based criteria was associated with survival outcome and might be useful for risk stratification of patients with newly diagnosed DLBCL receiving firstline R-CHOP/CHOP therapy.