摘要
目的:对比不同基线和中期PET/CT各参数对弥漫大B细胞淋巴瘤(DLBCL)化疗效果及预后进行评估的能力,以初步提出^(18)F⁃FDG PET对于DLBCL疗效评估及预后预测的更可靠指标。方法:回顾性收集了2015年1月1日至2020年12月31日在本院进行过^(18)F⁃FDG PET/CT检查和治疗后复查的DLBCL患者信息并进行补充随访。通过图像分析,获得基线PET/CT的最大标准化摄取值(SUV_(max))、肿瘤的最大径(MTD)、体重指数(BMI)校正的最远病灶距离(sD_(max))、肿瘤代谢体积(MTV)、肿瘤糖酵解总量(TLG)和中期PET/CT较基线的代谢变化量ΔSUV_(max)、ΔMTV、ΔTLG,并通过受试者操作特征(ROC)曲线确定最佳阈值,再根据该阈值进行分组,比较不同参数对于疗效、预后的预测能力,获得最佳预测疗效及预后的PET/CT参数。结果:回顾性分析82例DLBCL患者PET/CT和临床及预后数据。其中男性44例,女性38例,年龄21~84(55.4±16)岁。随访时间的中位数为28(5~60)个月,3年无进展生存(PFS)为72%,3年总生存(OS)为76%。CR组与PD组的SUV_(max)、MTD、sD_(max)、MTV、TLG均有显著差异(均P<0.05)。基线PET扫描所有代谢参数AUC均在0.7以上。基线PET参数中,TLG对于PFS和OS的预测能力最佳,AUC值分别为0.82和0.86,灵敏度为0.86和0.74,特异度分别为0.87和0.73,最佳阈值为5970。治疗2个周期后的中期PET代谢参数较基线水平减低百分比(ΔSUV_(max)、ΔMTV、ΔTLG)对于PFS和OS具有更高的预测价值,AUC值分别为0.79、0.83、0.84和0.81、0.87、0.89。ΔTLG预测能力最佳,最佳阈值为较基线PET降低31.9%。sD_(max)和TLG均高的患者预后较具有二者之一或二者均低的患者更差,差异有统计学意义(P<0.001)。结论:基线及中期PET/CT的多个参数对于DLBCL患者疗效预测与监测、生存评估具有确切的价值。基线PET/CT的sD_(max)与TLG及中期PET/CT计算的ΔTLG可能对于预测疗效及预后的价值更高。
Purpose:To propose a more reliable index of ^(18)F-FDG PET/CT for the observation of curative effect and prognosis prediction of diffuse large B-cell lymphoma(DLBCL)through comparing the value of baseline and mid-term of PET/CT imaging parameters in evaluation of the chemotherapy effect and prognosis in the DLBCL patients.Methods:The information of DLBCL patients who underwent ^(18)F-FDG PET/CT examination and posttreatment review in our hospital from January 1,2015 to December 31,2020 were retrospectively collected and followed up.The_(max)imum standard uptake value(SUV_(max)),_(max)imum tumor diameter(MTD),body mass index(BMI)corrected_(max)imum lesion distance(sD_(max)),tumor metabolic volume(MTV)and total glycolysis(TLG)and metabolic changes of mid-term PET/CT were compared with baselineΔSUV_(max),ΔMTV andΔTLG,and the best threshold through the receiver operator characteristic(ROC)curve was determined.Then all the patients were divided into groups according to the threshold,the predictive ability of different parameters for curative effect and prognosis were compared,and the best PET/CT parameters for predicting curative effect and prognosis were obtained.Results:The PET/CT and clinical and prognostic data of 82 patients with DLBCL were analyzed retrospectively.There were 44 males and 38 females,with an average age of(55.4±16)years(21-84 years).The median follow-up time was 28 months(range:5-60 months),the 3-year progression-free survival(PFS)was 72%,and the 3-year overall survival(OS)was 76%.There were significant differences in SUV_(max),MTD,sD_(max),MTV and TLG between CR(complete response)group and PD(partial response)group(P<0.05).The AUC of all metabolic parameters in baseline PET scan was above 0.7.Among the baseline parameters,TLG was with the best predictive ability for PFS and OS,AUC values were 0.82 and 0.86,sensitivity was 0.86 and 0.74,specificity was 0.87 and 0.73,and the best threshold was 5970.Percentage reduction of mid-term pet metabolic parameters from baseline after 2 cycles of treatment(ΔSUV_(max),ΔMTV,ΔTLG)were with higher predictive value for PFS and OS,and AUC values were 0.79,0.83,0.84 and 0.81,0.87 and 0.89,respectively.The best predictive threshold ofΔTLG was decrease 31.9%than that of baseline.DLBCL patients with high sD_(max)and TLG were with worse prognosis than those with one or both of low sD_(max)and TLG(P<0.001).Conclusion:The parameters of PET/CT are valuable for the evaluation of baseline and mid-term survival of DLBCL patients.sD_(max)and TLG of baseline PET/CT andΔTLG of mid-term PET/CT may be of higher value in predicting curative effect and prognosis.
作者
李书家
高克克
李昱旻
赵彤
孙爱君
LI Shujia;GAO Keke;LI Yumin;ZHAO Tong;SUN Aijun(Image Center,Wanjie Hospital)
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2022年第1期96-103,共8页
Chinese Computed Medical Imaging
关键词
弥漫大B细胞淋巴瘤
正电子发射计算机体层显像
疗效评估
预后预测
代谢参数
Diffuse large B‐cell lymphoma
Positron emission tomography and computed tomography
Efficacy evaluation
Prognosis prediction
Metabolic parameters
