^(18)F-FDG PET/CT代谢参数联合炎性反应指标对原发胃肠道DLBCL患者中期疗效的预测价值

Predictive value of ^(18)F-FDG PET/CT metabolic parameters combined with inflammatory markers for medium-term outcome in patients with primary gastrointestinal diffuse large B cell lymphoma

目的探索^(18)F-FDG PET/CT代谢参数联合炎性反应指标对原发胃肠道弥漫性大B细胞淋巴瘤(PGI-DLBCL)初诊患者中期化疗疗效的预测价值。方法回顾性分析2011年4月至2020年5月间于海军军医大学附属长海医院以^(18)F-FDG PET/CT进行基线评估且采用环磷酰胺+阿霉素+长春新碱+泼尼松(CHOP)或利妥昔单克隆抗体+CHOP(R-CHOP)化疗方案的67例PGI-DLBCL患者(男37例、女30例,年龄28~85岁)资料,2~4个化疗周期后行中期疗效评估,根据Lugano淋巴瘤疗效评估标准分为完全缓解(CR)组和非CR(NCR)组。采用Mann-Whitney U检验比较2组间SUV_(max)、SUV峰值(SUVpeak)、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)、血小板/淋巴细胞比值(PLR)和中性粒细胞/淋巴细胞比值(NLR)的差异。采用多因素logistic回归分析NCR的独立危险因素,根据筛选结果建立二元logistic回归模型,并用外部验证数据(n=15)对该模型进行检验。结果67例PGI-DLBCL患者中,CR组28例(41.8%),NCR组39例(58.2%)。CR组和NCR组的SUVpeak、MTV、TLG、PLR及NLR分别为9.5(6.2,15.2)和17.3(12.3,28.1)、11.3(4.7,23.2)和73.8(42.9,141.7)cm^(3)、85.2(35.5,214.6)和887.5(300.9,2075.3)g、149.3(102.8,173.1)和203.9(155.7,297.1)、2.2(1.8,4.6)和3.9(3.0,4.9),差异均有统计学意义(z值:-6.41~-2.33,均P<0.05)。建立回归模型:P=1/(1+e-x),x=0.100×MTV+0.024×PLR-8.064,其对NCR风险的预测准确性达86.57%(58/67),外部验证数据检验回归方程的准确性为13/15。结论PET/CT代谢参数MTV联合炎性反应指标PLR对初诊PGI-DLBCL患者行CHOP或R-CHOP化疗方案的中期疗效有较高的预测价值。

Objective To explore the predictive value of ^(18)F-FDG PET/CT metabolic parameters combined with inflammatory markers for the medium-term efficacy of chemotherapy in patients with primary gastrointestinal diffuse large B cell lymphoma(PGI-DLBCL).Methods From April 2011 to May 2020,67 patients(37 males,30 females,age:28-85 years)with PGI-DLBCL examined by ^(18)F-FDG PET/CT before chemotherapy in Changhai Hospital,Navy Medical University were retrospectively analyzed.All patients were treated with cyclophosphamide+doxorubicin+vincristine+prednisone(CHOP)or rituximab+CHOP(R-CHOP)regimens,and the medium-term efficacy was evaluated after 2-4 cycles of chemotherapy.The effect outcome was divided into complete remission(CR)group and non-CR(NCR)group based on the Lugano lymphoma response evaluation criteria.Mann-Whitney U test was used to compare the differences of SUV_(max),peak of SUV(SUVpeak),metabolic tumor volume(MTV),total lesion glycolysis(TLG),platelet/lymphocyte ratio(PLR)and neutrophil/lymphocyte ratio(NLR)between two groups.The independent risk factors of NCR were analyzed by multivariate logistic regression and the binary logistic regression model was established according to the results.The model was tested with external validation data(n=15).Results Of 67 PGI-DLBCL patients,28(41.8%)were CR and 39(58.2%)were NCR.SUVpeak,MTV,TLG,PLR and NLR in NCR group(17.3(12.3,28.1),73.8(42.9,141.7)cm^(3),887.5(300.9,2075.3)g,203.9(155.7,297.1),3.9(3.0,4.9))were significantly higher than those in CR group(9.5(6.2,15.2),11.3(4.7,23.2)cm^(3),85.2(35.5,214.6)g,149.3(102.8,173.1),2.2(1.8,4.6);z values:from-6.41 to-2.33,all P<0.05).The logistic regression model was as follows:P=1/(1+e-x),x=0.100×MTV+0.024×PLR-8.064.The prediction accuracy for NCR risk was 86.57%(58/67),with the accuracy of 13/15 tested by external validation data.Conclusion MTV combined with PLR has a good predictive value for medium-term efficacy of CHOP/R-CHOP chemotherapy in patients with PGI-DLBCL.