氟脱氧葡萄糖PET/CT在原发性胃肠道淋巴瘤化疗中期预后评估中的价值

Prognostic value of^(18)F-fluorodeoxyglucose PET/CT during interim chemotherapy for primary gastrointestinal lymphoma

目的探讨氟脱氧葡萄糖(^(18)F-FDG)PET/CT显像Deauville评分和最大标准化摄取值的变化值(ΔSUV_(max))在原发性胃肠道淋巴瘤(PGIL)化疗中期预后评估中的价值。方法回顾性分析2012年1月至2019年12月于唐山市工人医院就诊的54例PGIL化疗中期^(18)F-FDG PET/CT资料,对ΔSUV_(max)、ΔSUV_(max)%进行受试者操作特征(ROC)曲线分析,分别对ΔSUV_(max)及ΔSUV_(max)%最佳界值、Deauville评分分组,采用Kaplan-Meier生存曲线和Cox回归分析其预后评估能力及相关性。结果54例患者中,进展组21例,未进展组33例,2组ΔSUV_(max)均值差异有统计学意义(5.37±4.19 vs 8.14±5.29,t=2.134,P=0.038),2组ΔSUV_(max)%中位数差异有统计学意义(44.12%vs 73.53%),Z=-3.380,P=0.001)。ΔSUV_(max)及ΔSUV_(max)%曲线AUC分别为0.651(95%CI:0.502~0.800,P=0.064)、0.775(95%CI:0.641~0.909,P=0.001),分别以界值10.35、64.86%分组,Kaplan-Meier显示3年无进展生存(PFS)(52.4%vs 91.7%、36.4%vs 78.1%)差异均有统计学意义(P均<0.01)。Deauville<4分(PET阴性)组与和Deauville≥4分(PET阳性)组3年PFS差异有统计学意义(92.0%vs 34.5%,P<0.01)。Deauville评分与ΔSUV_(max)及ΔSUV_(max)%呈负相关(P<0.05)。Cox多因素分析结果显示,Deauville评分及ΔSUV_(max)为独立预测因素(P<0.05)。结论Deauville评分法和ΔSUV_(max)法在PGIL化疗中期预后评估均有较高价值,Deauville评分及ΔSUV_(max)为PFS的独立预测因素。

Objective To evaluate the prognostic value of ^(18)F-fluorodeoxyglucose(^(18)F-FDG)PET/CT Deauville score and the change in the maximum standardized uptake value(ΔSUV_(max))during interim chemotherapy for primary gastrointestinal lymphoma(PGIL).Methods ^(18)F-FDG PET/CT results of fifty-four patients with PGIL undergoing interim chemotherapy in Tangshan Gongren Hospital from January 2012 to December 2019 were collected for this retrospective analysis.A receiver operating characteristic(ROC)curve was used to estimate the optimal cutoff value of theΔSUV_(max),ΔSUV_(max)%,and Deauville score.Kaplan-Meier curve and Cox regression analysis were used to determine the prognostic value of these indictors.Results There was disease progression in twenty-one of the fifty-four patients,and thirty-three did not experience disease progression.The difference of means of theΔSUV_(max)between the two groups was statistically significant(5.37±4.19 vs 8.14±5.29,P<0.05).The difference of medians of theΔSUV_(max)%between the two groups was statistically significant(44.12%vs 73.53%,P<0.05).The AUC of the ROC curve for theΔSUV_(max)andΔSUV_(max)%were 0.651(P=0.064)and 0.775(P=0.001),respectively.The cutoff of theΔSUV_(max)andΔSUV_(max)%were 10.35 and 64.86%,respectively.Kaplan-Meier analysis showed that the difference in the three-year PFS between the lower and higherΔSUV_(max)(52.4%vs 91.7%)and between the lower and higherΔSUV_(max)%(36.4%vs 78.1%)were statistically significant(P<0.01).The difference in the three-year PFS between Deauville score<4(PET negative)and Deauville score≥4(PET positive)was statistically significant(92.0%vs 34.5%,P<0.01).Deauville score was negatively correlated with theΔSUV_(max)andΔSUV_(max)%.The multivariate Cox analysis results showed that Deauville score andΔSUV_(max)were significant prognostic factors for PFS.Conclusion Deauville score and theΔSUV_(max)have high prognostic value during interim chemotherapy for PGIL.Deauville score and theΔSUV_(max)were the significant prognostic factors for PFS.