^(18)F-FDG PET/CT参数预测弥漫大B细胞淋巴瘤中期疗效的应用研究

Predictive value of ^(18)F-FDG PET/CT parameters for interim treatment response in patients with diffuse large B-cell lymphoma

目的探讨^(18)氟-脱氧葡萄糖(^(18)F-FDG)PET/CT参数对弥漫大B细胞淋巴瘤(DLBCL)R-CHOP化疗中期疗效的预测价值。方法选取2014年7月—2019年6月徐州医科大学附属医院收治并接受R-CHOP化疗的DLBCL患者,共79例。根据中期疗效将上述患者分为完全缓解(CR)组和非完全缓解(非CR)组。比较2组间治疗前PET/CT定量参数的差异,采用受试者工作特征(ROC)曲线对变量取最佳阈值。采用多因素logistic回归分析评估中期疗效的独立预测因素,并用ROC曲线分析评价logistic回归模型的效能。结果79例DLBCL患者化疗中期CR 48例,非CR组31例(PR17例、SD5例、PD9例)。2组间最大病灶肿瘤代谢体积(MTVmax)、总肿瘤代谢体积(MTVsum)、最大病灶糖酵解(TLGmax)、总糖酵解(TLGsum)、最大病灶的最大直径(Dmax)、乳酸脱氢酶(LDH)水平、国际预后指数(IPI)、受侵结外脏器数目和病灶内坏死情况比较,差异有统计学意义(P<0.05)。MTVmax、MTVsum、TLGmax、TLGsum、Dmax预测中期疗效的最佳阈值分别为57.2 cm^(3)、45.3 cm^(3)、756.0 g、1977.1 g和6.6cm,其中Dmax效能最高。多因素分析显示Dmax和IPI是中期疗效的独立预测因素。结论^(18)F-FDG PET/CT参数对DLBCL患者R-CHOP化疗中期疗效具有预测价值,可为临床治疗策略的选择和及时调整提供重要依据。

Objective To investigate the predictive value of ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)parameters for interim treatment response in patients with diffuse large B-cell lymphoma(DLBCL)receiving R-CHOP chemotherapy.Methods A total of 79 DLBCL patients who received R-CHOP chemotherapy in the Affiliated Hospital of Xuzhou Medical University from July 2014 to June 2019 were enrolled.According to their interim treatment response,they were divided into two groups:a complete response(CR)group and an incomplete response(non-CR)group.The differences of pre-treatment PET/CT quantitative parameters were compared between the two groups.The quantitative parameters included the maximum and summary of metabolic tumor volume(MTVmax and MTVsum),the maximum and summary of total lesion glycolysis(TLGmax and TLGsum),and the maximum diameter of the maximum lesion(Dmax).The receiver operating characteristic(ROC)curve was plotted to determine the cut-off values of the above parameters.The multiple logistic regression analysis was perform to evaluate the dependent predictive factors of interim treatment response,while the efficacy of the logistic regression model was assessed by ROC analysis.Results Among the 79 patients,48 patients were included in the CR group and 31 patients were included in the non-CR group.Statistical differences were found in MTVmax,MTVsum,TLGmax,TLGsum,Dmax,international prognostic index(IPI),lactate dehydrogenase(LDH),the number of extranodal organ involvement and lesion necrosis between the two groups(P<0.05).The optimal cutoff values for MTVmax,MTVsum,TLGmax,TLGsum and Dmax to predict interim treatment response were 57.2 cm 3,45.3 cm 3,756.0 g,1977.1 g and 6.6 cm,respectively,where Dmax had the highest efficacy.Multivariate analysis showed that Dmax and IPI were the independent predictive indicators for interim treatment response.Conclusions ^(18)F-FDG PET/CT parameters may be used as predictive factors for interim treatment response in DLBCL patients treated with R-CHOP,which can provide important information for the selection and timely adjustment of clinical treatment strategy.