^18F-FDG PET-CT评估在接受白体造血干细胞移植的弥漫大B细胞淋巴瘤患者中的预后意义

Prognostic significance of ^18F-fluorodeoxyglucose positron emission tomography in patients with diffuse large B cell lymphoma undergoing autologous stem cell transplantation

目的探讨^18F-FDG PET-CT评估在接受auto-HSCT的弥漫大B细胞淋巴瘤（DLBCL）患者中的预后价值。方法回顾性分析2010年11月至2014年12月在北京大学肿瘤医院接受auto-HSCT的48例DLBCL患者资料，所有患者移植前或者移植后行PET-CT检查，结合患者基本临床特征及生存进行相关性分析。结果①48例患者中，男27例，女21例，中位年龄为43（17-59）岁。②移植前PET-CT评估阴性和阳性患者的3年无进展生存（PFS）率分别为87.1%和53.3%（χ^2=7.02，P=0.019），3年总生存（OS）率分别为90.3%和60.0%（χ^2=6.51，P=0.022）；移植后两组患者的3年PFS率分别为94.1%和30.0%（χ^2=22.75，P=0.001），3年OS率分别为97.1%和40.0%（χ^2=21.09，P=0.002）。③多因素分析结果显示，移植后PET-CT评估阳性是影响患者PFS（HR=13.176，P=0.005）和OS（HR=20.221，P=0.007）的预后不良因素；移植前治疗方案数与PFS相关（HR=10.039，P=0.040）。④Harrell’s C值显示移植后PET-CT评估与移植前治疗方案数联合使用预测PFS的价值优于单独使用（联合使用、移植前治疗方案数、移植后PET-CT评估的Harrell’s C值分别为0.976、0.869、0.927）；移植后PET-CT与ECOG体力状态评分联合使用能更好预测OS（联合使用、ECOG体力状态评分、移植后PET-CT评估的Harrell’s C值分别为0.973、0.711、0.919）。结论移植后PET-CT评估在接受auto-HSCT的DLBCL患者中有重要预后作用，移植后PET-CT评估联合移植前治疗方案数以及ECOG体力状态评分可能能够更好地预测患者预后。

ObjectiveTo evaluate the prognostic value of ^18F-fluorodeoxyglucose positron emission tomography （PET）/computed tomography （CT） in patients with diffuse large B cell lymphoma （DLBCL） undergoing autologous hematopoietic stem cell transplantation （auto-HSCT）.MethodsForty-eight patients with DLBCL treated at Peking University Cancer Hospital between November 2010 and December 2014 were assessed. All patients underwent PET/CT scanning prior to or after auto-HSCT. Correlation analysis was done based upon patients characteristics, PET/CT scan results and survival.Results①Among 48 patients, 27 was male, 21 female, median age was 43 （17-59） years old. ② Patients with negative pre-auto-HSCT PET/CT assessment demonstrated significantly better 3-year progression free survival （PFS） （87.1% vs 53.3%, χ^2=7.02, P=0.019） and overall survival （OS） （90.3% vs 60.0%, χ^2=6.51,P=0.022） than patients with positive pre-auto-HSCT PET/CT assessment. Three-year PFS （94.1% vs 30.0%, χ^2=22.75, P=0.001） and OS （97.1% vs 40.0%, χ^2=21.09, P=0.002） were also significantly different between patients with negative and positive post-auto-HSCT PET/CT assessment. ③ Multivariate analysis indicated a significant association of PFS （HR=13.176, P=0.005） and OS （HR=20.221, P=0.007） with post-auto-HSCT PET/CT assessment. Number of prior treatment regimens was associated with PFS （HR=10.039, P=0.040）. ④ Harrell’s C index revealed that the value of combined use of number of prior treatment regimens and post-auto-HSCT PET/CT assessment was superior to either one used alone in PFS （Harrell’s C values were 0.976, 0.869 and 0.927 in combined use, number of prior treatment regimens and post-auto-HSCT PET/CT assessment, respectively）, and the combined use of ECOG performance status and post-auto-HSCT PET/CT assessment significantly increased the Harrell’s C index in OS （Harrell’s C values were 0.973, 0.711 and 0.919 in combined use, ECOG performance status and post-auto-HSCT PET/CT assessment, respectively）.ConclusionsPost-auto-HSCT PET/CT assessment is the main predictor of outcomes in DLBCL patients receiving auto-HSCT. Combined use of post-auto-HSCT PET/CT assessment and number of prior treatment regimens and ECOG performance status is a better prognostic tool in patients with DLBCL undergoing transplantation.