18F-FDG PET/CT Deauville评分和IHP标准在弥漫性大B细胞淋巴瘤疗效评估中的应用

Prognostic value of Deauville criteria and IHP criteria in 18F-FDG PET/CT for clinical evaluation at the end of treatment in diffuse large B-cell lymphoma

目的比较18F-脱氧葡萄糖(FDG)PET/CT Deauville评分和国际统一标准化项目(IHP)标准在弥漫性大B细胞淋巴瘤(DLBCL)疗程结束后疗效评估中的价值。方法回顾性分析2010年2月至2018年6月间212例[男119例,女93例,平均年龄59.6(10~88)岁]疗程结束后行18F-FDG PET/CT评估疗效的DLBCL患者。分别采用IHP标准、Deauville评分3~5分(DC3)和Deauville评分4~5分(DC4)分析图像,以随访结果为"金标准",分析3种标准的疗效评估效能。相关分析采用Spearman秩相关。进行Kaplan-Meier生存分析和Cox回归分析,探讨不同标准与无进展生存(PFS)、总生存(OS)的关系。结果DC4评估疗效的阳性预测值和准确性分别为96.8%(61/63)、94.3%(200/212);IHP标准相应指标为75.3%(67/89)、87.7%(186/212);DC3对应数据为82.9%(68/82)、92.0%(195/212)。IHP标准与Deauville评分间存在正相关性(rs=0.926,P<0.05)。IHP标准阳性、DC3阳性与DC4阳性患者的2年PFS率分别为78.7%、76.5%、69.8%,阳性组与阴性组(95.6%、94.7%、97.2%)比较差异有统计学意义(χ^2=14.415、18.293与26.920,均P<0.05);2年OS率差异也有统计学意义(χ^2=9.597、11.149与17.416,均P<0.05)。Deauville评分为1、2、3、4、5分组的2年PFS率分别为95.3%、91.7%、93.3%、88.9%、55.6%,差异有统计学意义(χ^2=48.199,P<0.05)。多因素Cox回归分析结果表明Deauville评分与PFS密切相关(P<0.05)。结论IHP标准、DC3与DC4均对淋巴瘤预后具有预测价值,DC4预测价值最优,且Deauville评分与疾病进展状态密切相关。

Objective To evaluate the diagnostic efficiency and prognostic value of 18F-fluorodeoxyglucose (FDG) PET/CT for response assessment after treatment in patients with diffuse large B-cell lymphoma (DLBCL) when using the Deauville criteria and International Harmonization Project (IHP) criteria. Methods A total of 212 patients (119 males, 93 males, average age: 59.6(10-88)years) with DLBCL from February 2010 to June 2018 were analyzed. All subjects underwent restaging PET/CT after treatment. Images were evaluated with the IHP criteria, Deauville score of 3-5 (DC3) and Deauville score of 4-5 (DC4). The diagnostic efficiency of the 3 criteria for treatment effect was assessed and follow-up results were used as the gold standard. Spearman rank correlation analysis was used. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier analysis and Cox proportional hazards model. Results The positive predictive value and accuracy of DC4 for treatment effect evaluation were 96.8%(61/63) and 94.3%(200/212), those of IHP criteria were 75.3%(67/89) and 87.7%(186/212) respectively, and those of DC3 were 82.9%(68/82) and 92.0%(195/212) respectively. IHP criteria results and Deauville scores were correlated(rs=0.926, P<0.05). The 2-year PFS rates in IHP-, DC3- and CD4-positive groups were 78.7%, 76.5% and 69.8%, respectively, and those in IHP-, DC3- and CD4-negative groups were significantly higher (95.6%, 94.7%, 97.2%;χ^2=14.415, 18.293 and 26.920, all P<0.05). The similar results were found for OS rates (χ^2=9.597, 11.149 and 17.416, all P<0.05). The 2-year PFS rates in Deauville score of 1, 2, 3, 4, 5 groups were 95.3%, 91.7%, 93.3%, 88.9% and 55.6% respectively (χ^2=48.199, P<0.05). Cox-regression analysis showed significant correlation between Deauville criteria and 2-year PFS rate (P<0.05). Conclusions PET/CT with DC4, DC3 and IHP criteria have high predictive values for treatment outcome, and DC4 is the best. Cox regression analysis shows significant risk of progression by Deauville criteria.