^(18)F-FDG PET/CT显像在原发性胃肠道淋巴瘤中期疗效与预后评估中的价值

Value of ^(18)F-FDG PET/CT in the interim therapeutic and prognostic evaluation of primary gastrointestinal lymphoma

目的探讨^(18)F-FDG PET/CT显像及相关因素在原发性胃肠道淋巴瘤(PGIL)患者的中期疗效与预后评估中的价值。方法回顾性分析2008年1月至2018年1月间在上海交通大学医学院附属第一人民医院经病理证实为B细胞PGIL,且在化疗、放疗前及中期(3~4程)化疗后行^(18)F-FDG PET/CT显像的患者41例(男24例、女17例,年龄26~84岁),包括黏膜相关淋巴组织(MALT)淋巴瘤17例、弥漫性大B细胞淋巴瘤(DLBCL)24例。采用Mann-Whitney U检验比较MALT淋巴瘤和DLBCL患者治疗前代谢参数[SUV_(max)、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)]的差异;采用ROC曲线分析不同参数对无进展生存(PFS)的预测能力;采用Cox回归分析探讨PFS的影响因素。结果41例患者的中位随访时间为25(6~84)个月,3年PFS率为55.9%,总生存(OS)率为80.2%。治疗前,DLBCL患者的SUV_(max)(23.2±11.9)、MTV[260.7(66.2,740.7)cm^(3)]和TLG[1902.9(592.2,8418.1)g]均明显高于MALT淋巴瘤患者[7.9(6.2,9.8)、45.9(28.4,104.2)cm^(3)、121.1(72.8,295.6)g;z值:-4.02、-3.10、-3.92,均P<0.05]。DLBCL的治疗前后参数的变化值ΔSUV_(max)(AUC=0.80,P=0.012)、MALT淋巴瘤和DLBCL治疗前后参数变化率ΔSUV_(max)%(AUC=0.89,P=0.007;AUC=0.80,P=0.012)、ΔMTV%(AUC=0.91,P=0.005;AUC=0.77,P=0.026)和ΔTLG%(AUC=0.87,P=0.011;AUC=0.77,P=0.026)可预测PFS。Cox多因素分析示,MALT淋巴瘤的ΔSUV_(max)%是PFS的独立预测因素[风险比(HR)=17.192,95%CI:2.035~145.245,P=0.009],而ΔMTV%与ΔTLG%为DLBCL患者PFS的独立预测因素(均为HR=7.556,95%CI:1.968~29.016,P=0.003)。结论MALT淋巴瘤和DLBCL治疗前代谢参数有明显差异。治疗中期PET/CT能在MALT淋巴瘤和DLBCL的预后预测中提供有价值信息。

Objective To assess the value of ^(18)F-FDG PET/CT imaging and relevant factors in the interim therapeutic and prognostic evaluation of primary gastrointestinal lymphoma(PGIL)patients.Methods From January 2008 to January 2018,41 patients with B-cell PGIL(24 males,17 females;age:26-84 years)confirmed by pathology in Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine were retrospectively included.^(18)F-FDG PET/CT was performed before chemotherapy and radiotherapy and after 3-4 courses of chemotherapy.There were 17 cases of mucosa-associated lymphoid tissue(MALT)lymphoma and 24 cases of diffuse large B-cell lymphoma(DLBCL).Mann-Whitney U test was used to compare the differences of metabolic parameters(SUV_(max),metabolic tumor volume(MTV),total lesion glycolysis(TLG))before treatment between MALT lymphoma and DLBCL patients.ROC curve analysis was used to analyze the predictive abilities of different parameters for progression-free survival(PFS),and Cox regression analysis was used to analyze the influencing factors for PFS.Results The median follow-up time of 41 patients was 25(6-84)months,with the 3-year PFS rate of 55.9%and the overall survival(OS)rate of 80.2%.The baseline SUV_(max)(23.2±11.9),MTV(260.7(66.2,740.7)cm^(3))and TLG(1902.9(592.2,8418.1)g)in DLBCL were significantly higher than those in MALT lymphoma(7.9(6.2,9.8),45.9(28.4,104.2)cm^(3),121.1(72.8,295.6)g;z values:-4.02,-3.10,-3.92,all P<0.05).ΔSUV_(max) in DLBCL patients(AUC=0.80,P=0.012),ΔSUV_(max)%(AUC=0.89,P=0.007;AUC=0.80,P=0.012),ΔMTV%(AUC=0.91,P=0.005;AUC=0.77,P=0.026)andΔTLG%(AUC=0.87,P=0.011;AUC=0.77,P=0.026)in MALT lymphoma and DLBCL patients before and after treatment were predictive factors of PFS.Multivariate analysis showed thatΔSUV_(max)%was an independent factor for PFS of MALT lymphoma(hazard ratio(HR)=17.192,95%CI:2.035-145.245,P=0.009),whileΔMTV%andΔTLG%were factors for PFS of DLBCL(both HR=7.556,95%CI:1.968-29.016,P=0.003).Conclusions There are significant differences in metabolic parameters between MALT lymphoma and DLBCL before treatment.Interim PET/CT is effective for the prediction of prognosis of MALT lymphoma and DLBCL.