不同病理组织学分级滤泡淋巴瘤的临床PET-CT影像特征及预后研究

Prognostic value and imaging features of 18F-FDG PET-CT in follicular lymphoma with different histopathology grade

不同病理组织学分级滤泡淋巴瘤(FL)呈高度异质性,其生物学特性和临床管理方式存在差异。本研究回顾性分析山西省肿瘤医院161例不同病理组织学分级(1~2级、3A级、3B级)FL患者的^(18)F-氟代脱氧葡萄糖(FDG)PET-CT代谢参数、临床特征及其和预后的关系。病理组织学分级1~2级93例,3A级40例,3B级28例。LDH、CD10、EZH2、c-Myc、CD37蛋白表达与病理组织学分级(1~2级、3A级、3B级)有关(P值均<0.05),三组间的最大标准化摄取值(SUVmax)、糖酵解总量(TLG)、肿瘤-纵隔血池标准化摄取值比(TBR)和肿瘤-肝脏标准化摄取值比(TLR)差异均有统计学意义(P值均<0.05)。SUVmax、肿瘤代谢体积(MTV)、TLG、TBR、TLR预测FL疾病进展最佳界值分别为8.32、201.31、2342.55、6.56、3.52,大于界值组的患者疾病进展率增加(P值均<0.05)。血清β2微球蛋白(>2.3μg/L)、滤泡淋巴瘤国际预后指数(FLIPI-1)评分(3~5分)、CD37蛋白表达阴性、c-Myc蛋白表达阳性、TLG(>2342.55 g)均是影响FL患者无进展生存的独立危险因素(HR=3.609、2.509、0.255、3.506、13.531,P值均<0.05)。^(18)F-FDG PET-CT是FL病理组织学分级的有力补充,两者结合可以更好地预测FL患者的预后。

Follicular lymphoma(FL)is highly heterogeneous with different histopathologic grades.Its biological characteristics and clinical management are different.This study retrospectively analyzed^(18)F-FDG PET-CT metabolic parameters,clinical features,and their relationship with prognosis in 161 FL patients with different histopathological grades(grade 1-2,grade 3A,grade 3B)at the Shanxi Cancer Hospital.There were 93 cases in the grade 1-2 group,40 cases in the grade 3A group,and 28 cases in the grade 3B group.The expression of LDH,CD10,EZH2,c-Myc,and CD37 proteins was correlated with histological grade(grade 1-2,grade 3A,and grade 3B)(all P values<0.05).The SUVmax,TLG,TBR,and TLR for the three groups were different(all P values<0.05).The optimal thresholds of SUVmax,MTV,TLG,TBR,and TLR for predicting FL disease progression were 8.32,201.31,2342.55,6.56,and 3.52,respectively,and the rate of disease progression increased in patients with higher thresholds(all P value<0.05).β2-MG(>2.3μg/L),Follicular lymphoma international prognostic index-1(FLIPI-1)score(3-5 points),negative CD37 expression,positive c-Myc expression,and TLG(>2342.55 g)were all independent risk factors for PFS in the FL patients(HR=3.609,2.509,0.255,3.506,13.531,all P value<0.05).^(18)F-FDG PET-CT is a powerful complement to FL histopathological grading and the combination of the two may better predict the prognosis of FL patients.