18 F-FDG PET/CT探查初诊弥漫大B细胞淋巴瘤脾脏受累的预后价值

Prognostic Value of Splenic Involvement Detected by 18 F-FDG PET/CT in Newly Diagnosed Diffuse Large B Cell Lymphoma Patients

目的探讨18 F-FDG PET/CT探查到的初诊弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)脾脏受累的预后价值。方法回顾性分析2011年4月~2017年6月进行18 F-FDG PET/CT检查的84例初诊DLBCL住院患者的图像,采集其预后相关的临床资料(初诊时年龄、临床分期、ECOG评分、血清LDH水平、NCCN-IPI评分等),中位随诊时间20个月。定义脾脏有弥漫代谢活性增高、灶性代谢活性增高或脾大者为脾脏受累。脾脏弥漫代谢活性增高或灶性代谢活性增高者定义为脾肝比值>1组。统计分析18 F-FDG PET/CT探查的脾脏受累与预后相关临床资料的关系。结果K-M生存分析发现NCCN-IPI中高危+高危组相比于NCCN-IPI的低危+中低危组、脾肝比值>1组相比于脾肝比值≤1组、脾脏受累组相比于无脾脏受累组、有脾脏弥漫病变组相比于无脾脏受累组,具有较差的PFS(P<0.05)。但是COX回归分析发现仅有两组NCCN-IPI分型(P=0.009)和LDH是否升高(P=0.025)具有独立的预后价值。58例脾肝比值≤1的患者1年和2年PFS为78.1%,3年PFS为72.1%,5年PFS为61.8%;而26例脾肝比值>1的患者1年PFS为64.8%,2年和3年PFS为48.7%,5年PFS为32.5%,差异有统计学意义(P=0.042)。结论对于初诊DLBCL患者,18 F-FDG PET/CT探查是否有脾脏弥漫代谢活性增高或灶性代谢活性增高,对其预后有潜在的价值,脾脏弥漫或灶性代谢活性增高者复发/进展率更高。

Objective To investigate the prognostic value of splenic involvement detected by 18 F-FDG PET/CT in newly diagnosed diffuse large B cell lymphoma patients.Methods This research retrospectively analyzed newly diagnosed DLBCL patients in Beijing Hospital and their 18 F-FDG PET/CT imaging before treatment.The abnormal splenic PET/CT was defined as hypermetabolic lesion or diffusion hypermetabolism in spleen,with or without splenomegaly,on 18 F-FDG PET/CT.The progression-free survival(PFS)was calculated.‘Spleno-hepatic ratio greater than 1’was defined as hypermetabolic lesion or diffusion hypermetabolism in spleen.Follow-up was available in 84 patients over 27.5±20.8 months with a median of 20 months.Results In the Kaplan-Meier method with the log-rank test,the patients with abnormal splenic PET/CT had significantly lower PFS than patients without.Meanwhile,patients in high risk group+high risk group of the national comprehensive cancer network-international prognostic index(NCCN-IPI),or in‘spleno-hepatic ratio greater than 1’group,or with diffusion hypermetabolism in spleen,had significantly lower PFS(P<0.05).In COX regression analysis,only two NCCN-IPI groups(P=0.009)and LDH level(P=0.025)had independent clinical impacts on PFS.The 1-year and 2-year PFS was 78.1%,the 3-year PFS was 72.1%,and the 5-year PFS was 61.8%in 58 patients whose spleno-hepatic ratio was no greater than 1.Meanwhile,in the 26 patients with spleno-hepatic ratio greater than 1,the 1-year PFS was 64.8%,the 2-year and 3-year PFS was 48.7%,and the 5-year PFS was 32.5%.The two groups had comparative difference(P=0.042)with statistical significance.Conclusion For newly diagnosed DLBCL patients,18 F-FDG PET/CT can detect whether there is increased splenic diffuse or focal metabolic activity,which has potential value for their prognosis.Patients with increased splenic diffuse or focal metabolic activity have a higher recurrence/progression rate.