^(18)F-FDG PET/CT的基线代谢参数对弥漫大B细胞淋巴瘤预后评估的价值

The Value of Baseline Metabolic Parameters of ^(18)F-FDGPET/CT for Prognostic Assessment of Diffuse Large B-Cell Lymphoma

目的探讨^(18)F脱氧葡萄糖(^(18)F-FDG)PET/CT显像的代谢参数最大标准化摄取值(SUV_(max))、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)及临床指标对初诊弥漫性大B细胞淋巴瘤(DLBCL)的预后评估价值。方法回顾性分析94例经病理确诊DLBCL患者临床资料及治疗前的^(18)F-FDG PET/CT显像资料。以SUV_(max)的41%作为阈值,得出病灶的MTV和TLG,采用受试者工作特征曲线(ROC)分析判断以上3个参数预测无进展生存期(PFS)的最佳阈值。采用Pearson卡方检验、Kaplan-Meier法、Log-rank检验、单因素和多因素Cox回归分析与预后相关的因素。结果ROC曲线分析显示,SUV_(max)、MTV及TLG曲线下面积(AUC)分别为0.557(P=0.345)、0.871(P<0.001)和0.833(P<0.001)。因SUV_(max)的AUC较小,不能通过ROC曲线分析获得界值。MTV和TLG的最佳界值分别为138.77 cm^(3)、1998.62。将SUV_(max)、MTV和TLG分别以中位数及对应界值分为两组,Kaplan-Meier生存分析显示,MTV和TLG两组间PFS差异均有统计学意义(χ^(2)=35.887和30.435,P均<0.001),而SUV_(max)两组间PFS差异无统计学意义(χ^(2)=0.782,P=0.376)。高MTV和高TLG组,更易见大病灶直径、Ann Arbor分期晚、有B症状、乳酸脱氢酶(LDH)水平高、美国国家综合癌症网络IPI(NCCN-IPI)评分(4~8分)、美国东部肿瘤协作组(Ecog)评分(≥1分)、BCL-2蛋白表达阳性和MYC蛋白表达阳性的患者(χ^(2)4.066~24.266,P均<0.05)。多因素分析中,Ecog评分、MTV和TLG均是影响患者PFS的独立危险因素[相对危险度(RR):6.444~8.811,P均<0.05]。结论^(18)F-FDG PET/CT的参数MTV和TLG可作为预测DLBCL患者PFS的重要指标,两者的预测价值优于SUV_(max)。

Objective To investigate the prognostic value of ^(18)F deoxyglucose(^(18)F-FDG)PET/CT imaging maximum standardized uptake value(SUV_(max)),metabolic tumor volume(MTV),total lesion glycolysis(TLG)and clinical indicators for diffuse large B-cell lymphoma(DLBCL)before treatment.Methods The clinical data and ^(18)F-FDG PET/CT imaging data of 94 DLBCL patients diagnosed by pathology before treatment were retrospectively analyzed.MTV and TLG of the lesions were obtained with 41%of SUV_(max) as the threshold,and the optimal threshold for predicting progression-free survival(PFS)was determined by receiver operating characteristic curve(ROC)analysis.Pearson chi-square test,Kaplan-Meier test,Log-rank test,and univariate and multivariate Cox regression analysis were used to analyze the factors related to prognosis.Results The area under the curve(AUC)of SUV_(max) MTV and TLG were 0.557(P=0.345),0.871(P<0.001)and 0.833(P<0.001),respectively,according to ROC curve analysis.Because The AUC of SUV_(max) is small,the boundary value cannot be obtained by ROC curve analysis.The best thresholds for MTV and TLG were 138.77 cm^(3) and 1998.62,respectively.SUV_(max),MTV and TLG were divided into two groups by median and corresponding boundary value respectively.Kaplan-meier survival analysis showed that the PFS difference between MTV and TLG groups was statistically significant(χ^(2)=35.887 and 30.435,P均<0.001,all P<0.001),while the PFS difference between SUV_(max) groups was not statistically significant(χ^(2)=0.782,P=0.376).High MTV and TLG group,are more likely to see bulky disease,Ann Arbor stage later,B symptoms,lactate dehydrogenase(LDH)level higher,the national comprehensive cancer network(NCCN-IPI)score(4 to 8),the eastern United States tumor group(Ecog)score(≥1),the BCL 2 protein expression positive and MYC protein expression in patients with positive(χ^(2)=4.066-24.266,P<0.05).In multivariate analysis,Ecog score,MTV and TLG were all independent risk factors affecting PFS in patients[Relative risk(RR):6.444-8.811,all P<0.05].Conclusion MTV and TLG of^(18)F-FDGPET/CT can be used as important indicators to predict DLBCL patients,and their predictive value is superior to SUV_(max).