中期^(18)F-FDG PET/CT显像在弥漫性大B细胞淋巴瘤化疗预后评估方面的价值

The Prognosis Assessment Value of Interim ^(18)F-FDG PET/CT Imaging in the Chemotherapy of Diffuse Large B-cell Lymphoma

目的:探讨中期^(18)F-FDG PET/CT显像在弥漫性大B细胞淋巴瘤(DLBCL)化疗预后评估方面的价值。方法:回顾性分析2015年3月至2020年6月在四川省肿瘤医院就诊的97例DLBCL患者资料,使用ROC曲线计算SUVmax缩减率(△SUVmax%)预测预后的最佳截断值,比较△SUVmax%和Deauville五分法(5-PS)诊断效能差异,分析影响预后的因素。结果:根据ROC曲线,△SUVmax%评估患者预后的最佳截断值为74.9%,△SUVmax%≥74.9%患者的复发或进展率低于△SUVmax%<74.9%患者(均P<0.001);同时,5-PS<4分患者复发或进展率低于5-PS≥4分的患者(均P<0.001)。△SUVmax%与5-PS预测预后的特异度(83.7%vs 83.7%)和阴性预测值(87.3%vs 84.9%)均较高,敏感度(56.0%vs 52.2%)和阳性预测值均较低(53.8%vs 50.0%),△SUVmax%预测预后的准确率绝对值较5-PS高(78.3%vs 76.2%)。单因素分析结果显示,Ann Arbor分期、NCCN国际预后指数、△SUVmax%及5-PS与TTP及PFS相关(均P<0.001);进一步行多因素分析显示仅△SUVmax%是TTP及PFS的独立预测因子(均P<0.05)。结论:△SUVmax%与5-PS均能准确评估DLBCL患者治疗后的预后情况,但△SUVmax%在预后评估方面有更高的预测价值。

Objective: To investigate the prognostic value of interim ^(18)F-FDG PET/CT in patients with diffuse large B-cell lymphoma(DLBCL). Methods: A total of 97 patients with pathologically diagnosed DLBCL at Sichuan Cancer Hospital and Institute from March 2015 to June 2020 were enrolled in this retrospective study. Receiver operating characteristic analysis(ROC) was used to calculate the optimum maximum standard uptake value reduction ratio(△SUVmax%) cut-off value. The prognostic value of △SUVmax% and Deauville five-point scale(5-PS) in patients with DLBCL was compared, and the determined prognostic factors were analyzed. Results: ROC curve indicated that the optimum △SUV max% cut-off value was 74.9%. Patients with △SUVmax% ≥74.9% had a lower rate of progression or recurrence than those with △SUVmax% < 74.9%(both P<0.001). Meanwhile, patients with 5-PS score < 4 also had a lower rate of progression or recurrence than those with 5-PS score ≥4(both P<0.001). △SUVmax% and 5-PS had high specificity(83.7% vs 83.7%) and negative predictive value(87.3% vs 84.9%), while low sensitivity(56.0% vs 52.2%) and positive predictive value(53.8% vs 50.0%). △SUVmax% was more sensitive than 5-PS for the corresponding parameters(78.3% vs 76.2%). Univariate analysis showed that Ann Arbor stage, international prognostic index of National Comprehensive Cancer Network(NCCN-IPI), △SUVmax% and 5-PS were associated with TTP and PFS(all P<0.001).Multivariate analysis showed that △SUVmax% was an independent predictor of TTP and PFS(P=0.031, P=0.023).Conclusion: Both 5-PS and △SUVmax% can be used to evaluate the prognosis of DLBCL patients, but the predictive value of △SUVmax% is superior to that of 5-PS.