中期18F-FDG PET-CT两种图像判读法在弥漫性大B细胞淋巴瘤预后评估中的应用

目的:探讨中期正电子发射型计算机断层显像(positron emission tomography-computed tomography,PET-CT)Deauville五分法(Deauville five-point scale,5-PS)与最大标准摄取值缩减率(maximum standard uptake value variation,△SUVmax)两种图像判读法在弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者预后评估中的应用价值。方法:回顾性分析2012年10月至2018年6月重庆医科大学附属第一医院收治的94例DLBCL患者资料。采用Kaplan-Meier法及Cox比例风险回归模型进行生存资料分析,计算并采用χ2检验比较5-PS和△SUVmax对DLBCL患者预后预测的能力。结果:5-PS和△SUVmax分别以4分、86%进行分组。5-PS<4分组、△SUVmax≥86%组的患者无进展生存期(progression free survival,PFS)和总生存期(overall survival,OS)均优于5-PS≥4分组、△SUVmax<86%组的患者(P<0.05)。△SUVmax与5-PS对患者PFS和OS均有影响,较高的阴性预测值(89.4%,93.6%;76.1%,85.9%),较低的阳性预测值(48.9%,31.9%;47.8%,34.8%),并且△SUVmax对于患者的敏感性优于5-PS(82.1%,83.3%vs.39.3%,44.4%)。单因素分析中国际预后指数(international prognostic index,IPI)(P=0.007)、△SUVmax(P<0.001)、5-PS(P=0.014)及基线全身肿瘤代谢体积(total metabolic tumor volume,TMTV)(P=0.001)与PFS相关,△SUVmax(P=0.014)、5-PS(P=0.033)、TMTV(P=0.004)与OS相关;多因素分析显示TMTV是OS的独立预测因子(P=0.005),△SUVmax和TMTV是PFS的独立预测因子(P=0.002,P=0.020),并且△SUVmax<86%且高水平TMTV患者较低TMTV患者的PFS明显缩短(P=0.001)。结论:5-PS和△SUVmax均能初步评估DLBCL患者预后,但△SUVmax具有更高的预测价值,并且联合基线TMTV可以对DLBCL患者进行再次危险度分层。

Application of an interim 18F- FDG PET/CT interpretation method for evaluating the prognosis of diffuse large B-cell lymphoma

  Objective  To investigate the role of the Deauville five-point scale (5-PS) and maximum standard uptake value variation (△ SUVmax) measures of interim positron emission tomography/computed tomography (PET-CT) in the prognosis evaluation of patients with diffuse large B-cell lymphoma (DLBCL).  Methods  A total of 94 patients with histologically confirmed DLBCL at The First Affiliated Hospital of Chongqing Medical University from October 2012 to June 2018 were enrolled in this retrospective study. Clinical characteristics and prognostic factors of patients were analyzed. Survival data were analyzed using the Kaplan-Meier method and Cox proportional hazards model. The prognostic value of △SUVmax and 5-PS in patients with DLBCL was evaluated using the Chi-square test.  Results  5-PS and △SUVmax were grouped by scores of 4 and 86%, respectively. Progression free survival (PFS) and overall survival (OS) were longer in the 5-PS score < 4 group than in the 5-PS score ≥4 group. Patients in the △SUVmax ≥86% group had better PFS and OS than those in the △SUVmax < 86% group (P < 0.05). △SUVmax and 5-PS measures had high negative predictive values (89.4% and 93.6%, respectively; 76.1% and 85.9%, respectively) and low positive predictive values (48.9% and 31.9%, respectively; 47.8% and 34.8%, respectively) for PFS and OS. △SUVmax was more sensitive than 5-PS for the corresponding parameters (82.1% vs. 39.3% and 83.3% vs. 44.4%, respectively). Univariate analysis showed that international prognostic index (IPI) (P=0.007), △SUVmax (P < 0.001), 5- PS (P=0.014) and baseline total metabolic tumor volume (TMTV) (P=0.001) were associated with PFS. △SUVmax (P=0.014), 5-PS (P= 0.033), and TMTV (P=0.004) were related to OS. Multivariate analysis showed that TMTV was an independent predictor of OS (P= 0.005). △SUVmax and TMTV were independent predictors of PFS (P=0.002, P=0.020). The PFS of patients with △SUVmax < 86% and high TMTV was significantly shorter than that of those with △SUVmax < 86% with low TMTV (P=0.001).  Conclusions  5-PS and △SUVmax can be used to evaluate the prognosis of DLBCL patients. However, the predictive value of △SUVmax was higher than that of 5- PS, and combining △SUVmax with baseline TMTV could further stratify the risk of DLBCL patients.