治疗前^18F-FDG PET-CT显像预测中晚期弥漫大B细胞淋巴瘤预后的价值

Prognostic value of pretreatment 18F-FDG PET-CT for patients with advanced diffuse large B-cell lymphoma

目的探讨治疗前18F-脱氧葡萄糖（18F-FDG）正电子发射计算机断层扫描（PET-CT）显像中最大标准摄取值（SUVmax）、代谢体积（MTV）和病灶糖酵解总量（TLG）预测Ⅲ-Ⅳ期弥漫大B细胞淋巴瘤（DLBCL）患者预后的价值。方法回顾性分析72例Ⅲ-Ⅳ期DLBCL患者的临床资料，患者治疗前均行18F-FDGPET-CT检查。以SUVmax的40％作为阈值，获得全身肿瘤的SUVmax、MTV和TLG。采用受试者工作特征（ROC）曲线和ROC曲线下面积（AUC）分析SUVmax、MTV和TLG预测患者无进展生存时间（PFS）的最佳临界值。采用Kaplan-Meier法和Logrank检验进行单因素生存分析，多因素生存分析采用Cox比例风险模型。结果72例Ⅲ-Ⅳ期DLBCL患者的SUVmax、MTV和TLG分别为21．64、139．48cm^3和l413．77。ROC曲线分析显示，SUVmax的AUC为0．411（95％C7为0．279～0．544，P=0．195），MTV的AUC为0．688（95％凹为0．566～0．811．P=0．006）．TLG的AUC为0．526（95％CI为0．469～0．672，P=0．123）。由于SUVmax和TLG的AUC较小，以SUVmax和TLG的中位数21．64和1413．77作为临界值；MTV的临界值为69．71cm^3。多冈素分析显示，美国国立癌症综合网络脚际顶后指数为影响Ⅲ～Ⅳ期DLBCL患者无进展生存时间（PFS）和总生存时问（OS）的独立因素（均P〈O．05），而MTV与Ⅲ～Ⅳ期DLBCL患者的PFS和0s均无关（均P〉O．05）；MTV与Ⅲ期DLBCI。患者的PFS和0s均无关（均P〉0．05）；SUVmax、MTV和TLG与Ⅳ期DLBCL患者的无进展生存率和总生存率均无关（均P〉0．05）。结论治疗前18F-FDGPET-CT的SUVmax、MTV和TLG在预测Ⅲ-Ⅳ期DLBCL患者预后的价值不明确，尚不能判断患者的预后。

Objective To investigate the prognostic value of the maximum standardized uptake value （SUVmax）, metabolic tumor volume （MTV） and total lesion glyeolysis （TLG） measured by pretreatment lSF-FDG PET-CT in patients with stage Ⅲ- Ⅳ diffuse large B-cell lymphoma （DLBCL）. Methods Clinical data of 72 DLBCL patients with stage Ⅲ- Ⅳ disease undergoing a pretreatment PET-CT scan were retrospectively analyzed. SUVmax, MTV and TLG values of whole-body tumor were calculated from PET-CT images with a threshold of SUVmax 40% of tumor tissues. The optimal cutoff lines of SUVmax, MTV and TLG were obtained by ROC curve analysis. The Kaplan-Meier method and Log-rank test were used to perform univariate survival analysis, while Cox proportional hazards model was done for multivariate analysis. Results The SUVmax, MTV and TLG of 72 patients were 21.64, 139.48 em3 and 1 413.77, respectively. The areas under the ROC curve （AUC） of SUVmax, MTV and TLG were 0.411 （95% CI= 0.279-0.544, P=0.195）, 0.688 （95%CI=0.566-0.811, P=0.006） and 0.526 （95%CI= 0.469- 0.672, P = 0.123 ） , respectively. The median SUVrnax （ 21.64） and TLG（ 1 413.77 ） were used as the cutoff lines due to smaller AUC. The cutoff point of MTV was 69.71 cm^3. For DLBCL patients of stage Ⅲ- Ⅳ disease, univariate analysis showed that SUVmax and TLG were not associated with the progression-free survival （PFS） and overall survival （OS） （P〉 0.05 for all）. Multivariate analysis showed that National Comprehensive Cancer Network International Prognostic Index （NCCN-IPI） but not MTV was the independent prognostic predictor of PFS and OS （P 〈 0.05 for all）. And MTV was not the independent prognostic factor of PFS and OS for stage m DLBCL （P〉0.05 for all）. Conclusions For DLBCL patients with stage Ⅲ-Ⅳ disease, the prognostic value of SUVmax, MTV and TLG before treatment initiation are undetermined, and these indices cannot be used to predict the prognosis.