PET／CT用于评估弥漫大B细胞淋巴瘤预后的Meta分析

Meta analysis of PET/CT in evaluating prognosis of diffuse large B-cell lymphoma

目的评价PET/CT在预测弥漫大B细胞淋巴瘤(DLBCL)预后中的价值。方法计算机检索Pub Med、万方、Cochrane Library、EMBASE、中国知网、Medline等数据库中关于PET/CT评价DLBCL预后的研究,检索年限均为2000年1月至2015年3月。采用STATA11.0统计学软件进行Meta分析,各效应量均以95%可信区间(CI)表示。分析治疗中期PET/CT参数最大标准摄取值(SUV_(max))、治疗末期SUV_(max)和肿瘤代谢体积(MTV),并应用Meta分析合并风险比(HR)来评价DLBCL患者治疗后的预后与PET/CT参数的关系。分析各纳入研究结果间的异质性,采用随机效应模型对各研究结果进行Meta分析。评价指标包括无进展生存期(PFS)和总生存期(OS)的HR。结果共纳入11项研究,包括1068例初诊的DLBCL患者。Meta分析结果显示:(1)治疗中期(2~4化疗周期后)PET/CT SUV_(max)评价DLBCL患者PFS的HR为1.50(95%CI:1.12~2.01,P=0.007);(2)治疗末期(6~8化疗周期后)PET/CT SUV_(max)评价DLBCL患者PFS的HR为1.30(95%CI:0.74~2.29,P=0.369),评价DLBCL患者OS的HR为1.75(95%CI:0.74~4.17,P=0.204);(3)治疗末期PET/CT MTV评价DLBCL患者PFS的HR为2.17(95%CI:1.46~3.24,P=0.000),评价DLBCL患者OS的HR为2.99(95%CI 1.91~4.69,P=0.000)。结论治疗中期PET/CT的SUV_(max)可以预测患者的PFS;治疗末期PET/CT的MTV可以预测患者的PFS、OS,而SUV_(max)则不能预测患者的PFS、OS。

Objective To evaluate the prognostic value of PET/CT in the diffuse large B-cell lymphoma（DLBCL）. Methods All studies published up from January 2000 to March 2015 on the PET/CT in evaluating prognosis of DLBCL were searched from PubMed,Wan fang, Cochrane library, EMBASE, CNKI and Medline database. The STATA11.0 data analysis software was used for me- ta analysis. The effect of the volume was represented by 95% confidence intervals （CI）. The efficacy data included the maximum stand- ard uptake valne（SUVmax） Of the middle phase treatment and the SUVmax and metabolic tumor volume （MTV） at the end phase treat- ment. A meta analysis of the relationship between prognosis of DLBCL patients with these parameters was performed to generate com- bined hazard ratios （HRs） with 95% CI for overall survival （OS） and progression free survival（PFS）. Results Eleven studies, with 1068 patients in total diagnosed pathological types of DLBCL, were included for analysis. In the middle phase treatment （ after 2-4 cy- cles of chemotherapy）, the HR of PET/CT SUVmax in evaluating the PFS of DLBCL patients was[ 1.5 （ 1.12-2. 01 ）, P= 0. 007 ]. In the end phase treatment （after 6-8 cycles of chemotherapy） , the HR of PET/CT SUVmax in evaluating the PFS of DLBCL patients was [ 1.30 （0. 74-2. 29）, P=0. 369] ; the HR of PET/CT SUVmax in evaluating OS was[ 1.75 （0.74-4. 17）, P= 0. 204]. In the end phase treatment, the HR of PET/CT MTV in valuating PFS of DLBCL patients was[2. 17 （1.46-3. 24）, P=0. 000）]. The HR of PET/CT MTV in valuating the OS was [ 2. 99 （ 1.91-4. 69）, P = 0. 000 ]. Conclusion PET/CT SUVmax of middle treatment can be predicted PFS of patients with DLBCL. At the end of the treatment period, MTV of PET/CT can be predicted PFS and OS ,but PET/CT SUVmax cannot be predicted PFS and OS .