18F-FDG PET/CT代谢参数及临床指标在弥漫性大B细胞淋巴瘤中期评估及预后预测中的意义

目的 探讨¹⁸F-氟代脱氧葡萄糖（¹⁸F-FDG）PET/CT的代谢参数及临床指标在弥漫性大B细胞淋巴瘤（DLBCL）中期评估及预后预测中的意义。方法 收集194例DLBCL患者临床资料,记录患者的中期评估结果,比较不同临床指标β₂ -微球蛋白（β₂-MG）、双表达、三表达、Ann Arbor分期、淋巴瘤国际预后评分 （IPI）、多维尔5分法（D5PS）评分]和¹⁸F-FDG PET/CT代谢参数最大标准化摄取值（SUV_max）、病灶累及部位SUV_max的总和（SUV_maxsum）、平均标准化摄取值（SUV_mean）和SUV_max下降幅度（△SUV_max）]中达完全缓解（CR）者所占比例的差异,应用Cox回归和Kaplan-Meier生存分析法分析¹⁸F-FDG PET/CT代谢参数及临床指标对DCBCL患者2年无进展生存期（PFS）的影响,并对SUV_max与β₂-MG、Ann Arbor分期和IPI评分进行相关性分析。结果 β₂-MG > 2.3 mg/L、Ann Arbor分期Ⅲ/Ⅳ期、IPI > 2分、SUV_max > 17.00和SUV_maxsum > 38.60者达CR的比例较低;疗效达CR者△SUV_max大于未达CR者（P均 < 0.05）。Cox单因素分析显示,β₂-MG、Ann Arbor分期、IPI评分、双表达、三表达、SUV_maxsum及D5PS评分均与DLBCL患者2年PFS有关（P均 < 0.05）;多因素分析显示,Ann Arbor分期Ⅲ/Ⅳ期（HR = 4.486,P = 0.001）为DLBCL患者2年PFS的独立危险因素,D5PS 评分1~3分（HR = 0.256,P < 0.001）为DLBCL患者2年PFS的独立保护因素。Spearman秩相关分析显示,SUV_max与β₂-MG（r_s = 0.348,P = 0.001）、Ann Arbor分期（r_s = 0.236,P = 0.022）和IPI评分（r_s = 0.305,P = 0.003）均有关。结论 ¹⁸F-FDG PET/CT的代谢参数与临床指标相关,Ann Arbor分期和D5PS可作为DLBCL患者预后的参考指标。

Significance of metabolic parameters and biochemical indexes of 18F-FDG PET/CT in the mid-term evaluation and prognosis of diffuse large B-cell lymphoma

Objective To investigate the significance of metabolic parameters and biochemical indexes of ¹⁸F-FDG-PET/CT in the mid-term evaluation and prognosis of diffuse large B-cell lymphoma （DLBCL）. Methods Clinical data of 194 patients with DLBCL were analyzed retrospectively. The mid-term evaluation results were recorded. The proportion of patients who achieved complete remission （CR） was statistically compared among different clinical indexes（β₂-microglobulin （β₂-MG）, dual expression, triple expression, Ann Arbor stage, international prognostic index （IPI） and Deauville 5-point scale （D5PS） score） and metabolic parameters of ¹⁸F-FDG-PET/CT （the maximum standardized uptake value （SUV_max）, the sum of the maximum standardized uptake value （SUV_maxsum）, the mean standardized uptake value （SUV_mean） and the maximum decrease range of SUV （△SUV_max））. The influence of metabolic parameters and biochemical indexes of¹⁸F-FDG-PET/CT on the 2-year progression-free survival （PFS） was evaluated by Cox regression models and Kaplan-Meier survival analysis. The correlation between SUV_max and β₂-MG, Ann Arbor stage and IPI score was analyzed. Results The proportion of patients with β₂-MG > 2.3 mg/L, Ann Arbor stage Ⅲ/Ⅳ, IPI score > 2, SUV_max > 17.00 and SUV_maxsum > 38.60 who achieved CR was significantly decreased, the △SUV_max of patients achieving CR was significantly higher than that of those without CR（all P < 0.05）. Univariate Cox regression analysis showed that β₂-MG, Ann Arbor stage, IPI score, dual expression, triple expression, SUV_maxsum and D5PS socre were significantly correlated with the 2-year PFS of DLBCL patients （all P < 0.05）. Multivariate analysis showed that Ann Arbor stage Ⅲ/Ⅳ （HR = 4.486, P = 0.001） was an independent risk factor for the 2-year PFS, and D5PS score of 1-3 （HR = 0.256, P < 0.001） was an independent protective factor for the 2-year PFS of patients with DLBCL. Spearman’s rank correlation analysis demonstrated that SUV_max was significantly associated with β₂-MG （r_s = 0.348, P = 0.001）, Ann Arbor stage （r_s = 0.236, P = 0.022） and IPI score （r_s = 0.305, P = 0.003）. Conclusions The metabolic parameters of¹⁸F-FDG-PET/CT are associated with clinical indexes. Ann Arbor stage and D5PS can be utilized as reference indexes for clinical prognosis of DLBCL patients.