弥漫大B细胞淋巴瘤治疗前^(18)F-FDG PET/CT显像中肿瘤相关指标与乳酸脱氢酶及预后的相关性分析

Correlation of tumor-related indicators of diffuse large B-cell lymphoma and lactate dehydrogenase with prognosis in ^(18)F-FDG PET/CT imaging before treatment

目的:探讨弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)治疗前^(18)F-氟代脱氧葡萄糖(^(18)F-fluorodeoxyglucose,^(18)F-FDG)PET/CT显像中肿瘤相关指标与乳酸脱氢酶(lactate dehydrogenase,LDH)、预后的相关性。方法:选择经病理检查确诊的DLBCL患者78例,治疗前均行^(18)F-FDG PET/CT,以Spearman相关性分析PET/CT显像中肿瘤相关指标[最大标准摄取值(maximum standard uptake value,SUV_(max))、代谢体积(metabolic tumor volume,MTV)、病灶糖酵解总量(total glycolysis of lesions,TLG)]与LDH水平及预后相关因子[Ann Arbor分期、国际预后指数(international prognostic index,IPI)、结节受侵部位数]的关系。以无进展生存期(progressionfree survival,PFS)为阳性事件,经受试者工作特征(receiver operating characteristic curve,ROC)曲线获取SUV_(max),MTV,TLG最佳界值点;统计3年PFS,以Cox比例风险模型分析影响PFS的独立因素。结果:SUV_(max)与LDH,Ann Arbor分期、IPI评分、结节受侵部位数均无相关性(P>0.05);MTV,TLG与LDH水平、Ann Arbor分期、IPI评分显著均呈正相关(均P<0.05)。截至随访,78例患者中位PFS时间为33个月,3年PFS为46.15%。以PFS为阳性事件,SUV_(max),MTV,TLG界值点分别为20.20,55.86 cm^3,816.69 g。Cox多因素回归分析发现:Ann Arbor分期,IPI评分,MTV,TLG是影响DLBCL患者PFS率的独立因素。结论:治疗前^(18)F-FDG PET/CT中MTV,TLG与LDH,Ann Arbor分期,IPI评分呈正相关,是影响DLBCL患者PFS的独立预后因素,而SUV_(max)对预后预测意义不大。

Objective： To investigate the correlation analysis between tumor related indicators of diffuse large B-cell lymphoma（DLBCL） and lactate dehydrogenase（LDH） and prognosis in ^18F-FDG PET/CT imaging before treatment. Methods： A total of 78 patients with pathologically confirmed DLBCL were selected and ^18F-FDG PET/CT imaging performed before treatment. We analyzed the correlation of tumor related markers [maximum standard uptake value（SUVmax）, metabolic tumor volume（MTV）, total glycolysis of lesions（TLG）] with the level of LDH and prognosis related factors [Ann Arbor stage, international prognostic index（IPI）, number of involved nodular sites] by Spearman correlation analysis. With progression-free survival（PFS） as the positive event, the optimal cut-off values of SUVmax, MTV and TLG were obtained through the receiver operating characteristic（ROC） curve. Three-year PFS rates were statistically analyzed, and Cox proportional hazard model was used to analyze independent factors affecting the PFS rate. Results： There was no correlation between SUVmax and Ann Arbor stage, IPI score and the number of involved nodular sites（P〈0.05）. MTV and TLG were positively correlated with the LDH level, Ann Arbor stage and IPI score（all P〈0.05）. At the end of follow-up, the median PFS time of 78 patients was 33 months, and the 9-year PFS rate was 46.15%. The cut-off values of SUVmax, MTV and TLG were 20.20, 55.86 cm^3 and 816.69 g respectively, with PFS as the positive event. Cox multivariate regression analysis showed that Ann Arbor stage, IPI score, MTV and TLG were independent influencing factors of PFS rate in patients with DLBCL. Conclusion： MTV and TLG in ^18F-FDG PET/CT imaging before treatment are positively correlated with LDH. Ann Arbor stage and IPI score which are independent factors influencing the PFS of patients with DLBC, while SUVmax is of little significance for predicting the prognosis.