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弥漫大B细胞淋巴瘤(DLBCL)是最常见的侵袭性非霍奇金淋巴瘤(NHL)。应用美罗华联合环磷酰胺、阿霉素、长春新碱、甲泼尼龙化疗方案后,DLBCL患者的治愈率可达60%~80%。由于DLBCL在分子病理等方面具有明显的异质性,不同患者的疗效和预后不同,因此如何正确评价其疗效及预后是目前研究的热点。18F-FDG PET/CT是DLBCL患者常用的疗效评价及预后评估的影像学工具。国际预测预后指数(IPI)以及美国国立综合癌症网络-国际预后指标(NCCN-IPI)是广泛应用于临床的恶性淋巴瘤预后评分系统。近年来,一些新的临床及分子病理因素的预后价值也先后被探索。笔者将对PET/CT、临床预后评分系统、不同的临床及分子病理预后因素在DLBCL患者的疗效评价及预后评估中的应用、研究进展以及发展趋势进行综述。 相似文献
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目的:探讨化疗结束时
18F-FDG PET/CT Lugano淋巴瘤疗效评估标准与弥漫性大B细胞淋巴瘤(DLBCL)患者预后的关系。
方法:回顾性分析2013年7月至2021年1月于河北医科大学第四医院诊治并于化疗结束时行
18F-FDG PET/CT的DLBCL患者131例[男63... 相似文献
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弥漫大B细胞淋巴瘤(DLBCL)是最常见的血液系统恶性肿瘤之一,常规采用利妥昔单抗联合环磷酰胺+阿霉素+长春新碱+泼尼松的治疗方案已将DLBCL的治愈率提高,但是不同患者的预后差异较大,目前预测预后的方法存在一定的局限性。18F-氟脱氧葡萄糖(FDG)PET/CT已广泛应用于DLBCL的诊疗中,其代谢参数代谢肿瘤体积(MTV)是DLBCL预后强有力的预测因子,但如何将MTV更好地应用于临床尚存在一些争议,笔者就MTV在DLBCL预后预测中的研究进展进行综述。 相似文献
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目的探讨影响原发性胃肠道非霍奇金淋巴瘤患者的临床特征和预后因素。方法回顾分析本院1998年1月~2009年12月收治的经病理证实的142例原发性胃肠道非霍奇金淋巴瘤患者的临床资料。应用Kaplan-Meier法进行生存分析,组间比较用Log-rank检验。结果本组病例3、5年生存率分别为73.94%(105/142)和62.68%(89/142)。单因素分析结果显示,肿块大小、临床分期、病理分型、治疗模式是影响患者预后的因素。伴随B症状、肿块≥10cm、临床分期ⅢE~ⅣE期、T细胞型、单一手术的预后较无B症状、肿块〈10cm、临床分期IE~ⅡE期、B细胞型、综合治疗差。结论有无B症状、肿瘤大小、临床分期、病理分型及治疗模式是影响原发性胃肠道非霍奇金淋巴瘤患者预后的独立危险因素。 相似文献
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弥漫性大B细胞淋巴瘤(DLBCL)是发病率较高的淋巴造血系统疾病,该病进展较快、病死率较高。如何通过现有的检查技术精确地对患者进行预后评估是研究者们面临的一大难题。目前,PET/CT以其能同时提供解剖及功能图像的独特优势,广泛地应用于淋巴瘤的治疗监测及预后评估中,但采用哪种评价体系对图像进行判读的准确率更高仍存在较大争议。笔者综述了PET/CT定性、半定量及其他新的评价体系在DLBCL预后评估中的应用价值。 相似文献
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目的 探讨治疗前18F-FDG PET/CT影像组学特征对弥漫大B细胞淋巴瘤(DLBCL)患者无进展生存期(PFS)及总生存期(OS)的预后评估。资料与方法 回顾性收集2016年1月—2018年12月解放军总医院第一医学中心经病理证实为DLBCL且治疗前行18F-FDG PET/CT的135例患者,以8∶2随机分为训练集和测试集,再以8∶2将训练集分为训练集和验证集进行模型构建。半自动勾画患者淋巴瘤病灶作为感兴趣区并提取特征,利用单因素COX及最小绝对收缩选择算子回归进行特征筛选,获得系数非零的影像组学特征并用其权重系数计算每例患者的影像组学得分(Radscore),分析Radscore对PFS和OS的预测价值。使用传统预后指标(代谢参数和临床因素)、Radscore及两者联合分别建立3种模型。通过C-index、时间依赖的受试者工作特征曲线、决策曲线评估各模型预测效能。最后基于最佳模型绘制列线图,利用校准曲线验证列线图效能。结果 联合模型对3、5年PFS及OS预测效能优于传统预后指标模型和Radscore模型(Z=0.962 1~2.253... 相似文献
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目的基于数据库分析ADD3基因在弥漫性大B细胞淋巴瘤(Diffuse Large B Cell Lymphoma,DLBCL)中的表达情况及临床意义。方法基于Oncomine数据库进行荟萃分析,筛选出在DLBCL中的差异表达基因ADD3,并进一步分析其在mRNA及DNA水平上的表达差异,从GEO数据库下载含有DLBCL患者信息的数据集,对ADD3的表达量与患者的预后进行生存分析,并进一步对年龄、性别等亚组进行分析。利用GEPIA2在线分析工具对DLBCL样本中ADD3与c-Myc、Blc2、P53等基因进行相关性分析,通过癌症基因图谱数据库分析网站(UALCAN)对ADD3在DLBCL患者中的表达进行验证分析,DLBCL中ADD3在性别、年龄、种族、疾病阶段等不同亚组的表达量进一步进行验证分析。结果ADD3在荟萃分析中位于显著低表达基因的104位,生存分析显示ADD3的表达量与患者的生存预后显著正相关,相关性研究显示ADD3与Bcl2、c-Myc、P53等基因呈现弱相关性,亚组分析显示ADD3的表达量与性别、种族等因素无关,21~40岁年龄组表达量均高于41~60岁、61~80岁、81~100岁年龄组,对年龄亚组进一步进行生存分析,结果显示ADD3低表达组预后更差,与先前的分析结果一致。结论ADD3在DLBCL中低表达,且与患者预后呈现显著正相关性,有望作为DLBCL的独立预后标志物,为治疗和DLBCL提供参考靶点。 相似文献
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目的 评价18F-FDG PET/CT对不同Bcl-2、Bcl-6及MYC蛋白表达的弥漫大B细胞淋巴瘤(DLBCL)患者的预后评估价值。资料与方法 回顾性纳入2015年1月—2020年1月苏州大学附属第一医院164例初诊DLBCL患者,根据免疫组化结果将病例分为对照组97例、双表达组30例及三表达组37例,记录一般资料、Bcl-2、Bcl-6、MYC蛋白表达情况及患者化疗前后的18F-FDG PET/CT表现,并对3组患者进行生存分析,研究最大标准化摄取值(SUVmax)、△SUVmax等对DLBCL患者预后的影响。结果 随访结束时,164例患者中死亡42例(25.61%),3组间总体生存率差异有统计学意义(χ2=49.105,P<0.05);进展49例(29.87%),3组间无进展生存率差异有统计学意义(χ2=78.224,P<0.05)。受试者工作特征曲线分析显示,化疗后SUVmax界值3.42,△SUVmax界值77.16%。SUVmax<3.42组和SUVmax≥3.42组... 相似文献
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Hye Kyung Shim Won Woo Lee So Yeon Park Haeryoung Kim Young So Sang Eun Kim 《Nuclear medicine and biology》2009,36(2):191-197
IntroductionDiffuse large B-cell lymphoma (DLBCL) has been reported to show higher uptake of 2-deoxy-2-F18-fluoro-d-glucose (FDG) by positron emission tomography than other B-cell non-Hodgkin's lymphomas (non-DLBCL). The authors addressed the mechanism of FDG uptake in DLBCL by immunostaining for glucose transporter Types 1 (Glut-1) and 3 (Glut-3) and hexokinase-II (HK-II) in excised lymphoma tissues.MethodsSixteen B-cell non-Hodgkin's lymphoma patients (11 DLBCL and 5 non-DLBCL patients) were included in the study because the lymphoma tissues obtained by excision were eligible for immunostaining. The expressions of Glut-1, Glut-3 and HK-II were assessed regarding the percentages of positively stained lymphoma cells (%expression), the staining intensities (none=0, weak=1, moderate=2 and strong=3) and the staining patterns (membranous or cytoplasmic) and compared between DLBCL and non-DLBCL.ResultsGlut-1 was not expressed at all in DLBCL or non-DLBCL, and their Glut-3 expressions were not significantly different (P>.05) with respect to %expression (mean±S.E.M., 73.6±7.3% vs. 72.0±3.7%), staining intensity (2.5±0.2 vs. 2.6±0.2) and staining pattern (membranous pattern dominant; 54.5% vs. 60.0%). However, DLBCL expressed more HK-II than non-DLBCL, i.e., %expression (45.2±11.5% vs. 17.0±15.8%, P=.0275) and staining intensity (2.3±0.2 vs. 0.6±0.4, P=.0032). HK-II showed a cytoplasmic location in DLBCL and non-DLBCL.ConclusionsHK-II and Glut-3 contribute significantly to FDG uptake in DLBCL. DLBCL may have higher FDG uptake because it expresses more HK-II, whereas Glut-1 appears to play no role in FDG uptake in B-cell non-Hodgkin's lymphoma. 相似文献
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PURPOSE: To analyze the influence of radiotherapy doses, chemotherapy doses, and clinical parameters on in-field disease control to assess the optimal radiation doses for treatment of non-Hodgkin's lymphoma according to the newly proposed WHO classification. PATIENTS AND METHODS: Subjects consisted of 35 extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) type, 75 diffuse large B-cell lymphomas (DLBCL), 14 follicular lymphomas, 17 extranodal natural killer (NK)/T-cell lymphomas, nasal type, eight unclassified peripheral T-cell lymphomas, four anaplastic large-cell lymphomas, T/null cell type, and five others. 59 patients received radiotherapy alone. 98 patients received CHOP, modified CHOP, or more intensive chemotherapy, and six patients were treated with other combination. RESULTS: No patients with MALT lymphoma had in-field local recurrence. There were no recurrences in DLBCL patients who received chemotherapy in which the doses of adriamycin were > 200 mg/m(2), nor in DLBCL patients who were treated with > 45 Gy. Only nine of 15 patients with T-cell lymphoma treated with < or = 50 Gy and three of five patients treated with > 50 Gy had local control. The dose of adriamycin had no influence on local control of T-cell lymphoma. CONCLUSION: T/NK-cell lymphomas were more radioresistant than B-cell lymphomas. The prognosis for peripheral T/NK-cell lymphomas is poor even when treated by irradiation combined with chemotherapy. 相似文献
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Kumar R Bhargava P Zhuang H Yu JQ Schuster SJ Alavi A 《Clinical nuclear medicine》2004,29(11):685-688
Spontaneous regression of non-Hodgkin lymphoma (NHL) has been reported in low-grade tumors but is an extremely rare event in intermediate- and high-grade disease. Documentation of spontaneous regression by serial fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging has not been reported in the literature. We present 3 cases of spontaneous regression, 1 each of follicular lymphoma (FL), mantle cell lymphoma (MCL), and diffuse large B-cell lymphoma (DLBCL), which showed spontaneous regression on serial FDG-PET imaging. All patients underwent serial whole-body FDG-PET scans 60 minutes after intravenous injection of 9-11 mCi of this radiotracer. None of them had any chemotherapy, radiotherapy, or surgery after the baseline PET scan. Spontaneous regression of disease in all 3 cases was correlated with conventional imaging and clinical course. All 3 patients had positive FDG-PET results on their baseline scan. There was complete disappearance of FDG uptake on a follow-up PET scan for the patient with follicular lymphoma. These results suggest complete regression. The patients with MCL and DLBCL both showed a significant reduction in FDG uptake on serial whole-body PET scans, suggesting partial regression in both cases. Although spontaneous regression of lymphoma is uncommon, this phenomenon can be successfully demonstrated by FDG-PET imaging. Therefore, serial PET imaging may play an important role in detecting this unusual event and may further enhance our understanding of the biologic behavior of this malignancy. 相似文献
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Gaetano Paone Emmanuel Itti Corinne Haioun Philippe Gaulard Jehan Dupuis Chieh Lin Michel Meignan 《European journal of nuclear medicine and molecular imaging》2009,36(5):745-750
Purpose To assess, in patients with diffuse large B-cell lymphoma (DLBCL), whether the low sensitivity of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for bone marrow assessment may be explained by histological characteristics
of the cellular infiltrate.
Methods From a prospective cohort of 110 patients with newly diagnosed aggressive lymphoma, 21 patients with DLBCL had bone marrow
involvement. Pretherapeutic FDG-PET images were interpreted visually and semiquantitatively, then correlated with the type
of cellular infiltrate and known prognostic factors.
Results Of these 21 patients, 7 (33%) had lymphoid infiltrates with a prominent component of large transformed lymphoid cells (concordant
bone marrow involvement, CBMI) and 14 (67%) had lymphoid infiltrates composed of small cells (discordant bone marrow involvement,
DBMI). Only 10 patients (48%) had abnormal bone marrow FDG uptake, 6 of the 7 with CBMI and 4 of the 14 with DBMI. Therefore,
FDG-PET positivity in the bone marrow was significantly associated with CBMI, while FDG-PET negativity was associated with
DBMI (Fisher’s exact test, p=0.024). There were no significant differences in gender, age and overall survival between patients with CBMI and DBMI, while
the international prognostic index was significantly higher in patients with CBMI.
Conclusion Our study suggests that in patients with DLBCL with bone marrow involvement bone marrow FDG uptake depends on two types of
infiltrate, comprising small (DBMI) or large (CBMI) cells. This may explain the apparent low sensitivity of FDG-PET previously
reported for detecting bone marrow involvement. 相似文献
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目的 探讨PDE4B、BCL-2在不同类型B细胞非霍奇金淋巴瘤(B cell non-Hodgkin Lymphoma,B-NHL)中的表达及其意义.方法 采用免疫组化方法检测93例不同类型B-NHL和10例反应性增生淋巴结中PDE4B、BCL-2的表达,并进行对比分析.结果 PDE4B、BCL-2在不同类型B-NHL中均有不同程度的表达,PDE4B在淋巴浆细胞淋巴瘤(LPL)、滤泡性淋巴瘤(FL)、边缘区淋巴瘤(MZL)表达较高;伯基特淋巴瘤(BL)均为阴性表达,各组间比较无统计学意义(P>0.05).BCL-2在FL与弥漫性大B细胞淋巴瘤(DLBCL)、淋巴母细胞性淋巴瘤(LBL)、黏膜相关淋巴组织结外边缘区淋巴瘤(MALT)各组表达比较有统计学意义(P<0.05).PDE4B在DLBCL的GCB亚型、non-GCB亚型阳性表达分别为61.54% (16/26),31.43% (11/35),差异有统计学意义(P<0.05).结论 PDE4B、BCL-2在不同类型B-NHL中均有不同程度的表达,二者在B-NHL的发生、发展中可能起着一定的作用.PDE4B表达与B-NHL的恶性程度和侵袭性可能存在负相关;BCL-2是诊断FL的一个重要指标. 相似文献
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Yasuka Kikuchi Noriko Oyama-Manabe Osamu Manabe Masanao Naya Yoichi M. Ito Kanako C. Hatanaka Hiroyuki Tsutsui Satoshi Terae Nagara Tamaki Hiroki Shirato 《European journal of nuclear medicine and molecular imaging》2013,40(9):1337-1344
Purpose
To investigate the specific imaging findings of multidetector row CT (MDCT) and PET/CT with18F-FDG in cardiac dominant diffuse large B-cell lymphoma (DLBCL) in comparison with other cardiac tumours.Methods
Five patients with DLBCL and 12 patients with other cardiac tumours including pericardial tumours were retrospectively reviewed. Among the patients with other cardiac tumours, seven had metastatic tumours, three had benign tumours, and two had other malignant cardiac tumours. The location of the cardiac mass, the encasement of the coronary artery surrounded by the mass, and pericardial effusion were evaluated using MDCT. The disease activity of the cardiac tumour was also evaluated by PET/CT.Results
Four of the five DLBCL patients had primarily right-sided cardiac lesions, which was seen significantly more frequently in DLBCL than in other cardiac tumours (p?=?0.028). All cardiac DLBCL lesions were located around the atrioventricular groove and encased the coronary arteries. ECG-gated cardiac MDCT showed that there was no apparent stenosis of the coronary arteries. Large amounts of pericardial effusion were seen in all DLBCL patients. PET/CT revealed significantly higher FDG uptake in DLBCL than in other cardiac malignant tumours, with no overlap (p?=?0.0007).Conclusion
The combination of a right-sided cardiac mass with a large pericardial effusion and no apparent stenosis of the encased coronary artery revealed by MDCT and a high maximum standard uptake value were the specific findings in cardiac dominant DLBCL. 相似文献17.
Tsujikawa T Okazawa H Tsuchida T Demura Y Imamura Y Fujibayashi Y 《Annals of nuclear medicine》2007,21(6):375-378
We recently experienced a case with uveitis suffering from fever of unknown origin suspected of being caused by sarcoidosis.
Chest computed tomography showed right supraclavicular, bilateral mediastinal, and right hilar lymphadenopathy, and intensive
abnormal uptake of 2-[18F]fluoro-2-deoxy-d-glucose (18F-FDG) was observed on positron emission tomography with 18F-FDG (FDG-PET). On the other hand, 67Ga scintigraphy showed almost no abnormal findings. Histopathological examination revealed the lesion to be a diffuse large
B-cell lymphoma (DLBCL), namely, an aggressive non-Hodgkin lymphoma from a right supraclavicular lymph node biopsy specimen.
Additional immunohistochemical analysis showed the negative expression of transferrin receptor (TfR) on the formalin-fixed
paraffin-embedded specimen. Although DLBCL is generally considered to be a 67Ga-avid tumor, it does not always have a large number of TfRs and that leads to a discrepancy between the 67Ga scintigraphy and FDG-PET findings. FDG-PET should be more appropriate for the initial staging of DLBCL than 67Ga scintigraphy, whereas 67Ga scintigraphy might be able to provide additional information including prognostic factors and to support strategies that
target TfR for cancer therapy. 相似文献
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Geon Wook Kang Hye Jin Kang Dong-Yeop Shin Ha Ra Gu Hong Seok Choi Sang Moo Lim 《Nuclear Medicine and Molecular Imaging》2013,47(4):281-284
We report a case that demonstrates the efficacy of radioimmunotherapy (RIT) with radioiodinated rituximab (131I-rituximab) for relapsed diffuse large B-cell lymphoma (DLBCL). A 79-year-old male patient with DLBCL initially achieved a complete response (CR) after six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) therapy. However, the lymphoma relapsed 20 months later. Although the patient had achieved a second and a third CR after two cycles of 90Y-ibritumomab tiuxetan, he experienced a third relapse approximately 3 years later. Between March and June 2011, the patient received three cycles of 131I-rituximab. Although he had achieved partial response after the second cycle, the disease progressed after the third cycle, and the total progression–free survival was thus 5 months. The patient suffered only relatively mild toxicity (grade 1 thrombocytopenia) during treatment. RIT with 131I-rituximab is therefore potentially effective in patients with relapsed DLBCL, even after the failure of 90Y-ibritumomab tiuxetan therapy. 相似文献