PET-CT定量参数与弥漫大B细胞淋巴瘤患者预后的相关性分析

摘 要：［目的］ 探讨弥漫大B细胞淋巴瘤（DLBCL）治疗前18F-FDG PET/CT显像中肿瘤SUVmax、SULmax、MTV、TLG与预后的相关性。［方法］回顾性分析诊治的116例DLBCL患者资料,所有患者治疗前行18F-FDG PET/CT显像,均有完整的临床随访数据。分析PET-CT代谢参数与预后的关系。［结果］ SUVmax、SULmax与DLBCL患者年龄、分期、Hans分型、结外病变个数及Ki-67间无相关性（P均＞0.05）。取SUVmax、SULmax、MTV、TLG中位数（分别为18.64、17.65、22.74、221.84）为界值,单因素分析显示Ann Arbor 分期、结外病变个数、Hans分型、 SULmax是患者 PFS 的影响因素（P均＜0.05）;多因素分析显示Ann Arbor 分期、结外病变个数、Hans分型是患者 PFS 的独立影响因素（P均＜0.05）。［结论］ 治疗前PET-CT定量参数对DLBCL患者预后预测意义不明确,目前还不能通过其来判断预后或指导治疗。     

程序性死亡受体配体1和2及磷酸化蛋白激酶B在弥漫大B细胞淋巴瘤中的表达及其临床意义

目的 探讨弥漫大B细胞淋巴瘤(DLBCL)患者程序性死亡受体配体1(PD-L1)、PD-L2及磷酸化蛋白激酶B(p-AKT)的表达情况,并分析其与临床病理特征和预后的关系.方法 选取山西省肿瘤医院2010年1月至2012年12月有详细随访记录的68例DLBCL患者存档石蜡标本,应用免疫组织化学法检测PD-L1、PD-L2和p-AKT蛋白的表达情况.结果 DLBCL患者PD-L1蛋白阳性率为22.1%(15/68),与是否为生发中心B细胞(GCB)亚型(χ^2=5.591,P=0.018)、临床分期(χ2=3.969,P=0.046)、国际预后指数(IPI)评分(χ^2=4.178,P=0.041)和治疗缓解率(χ^2=6.587,P=0.010)有关;PD-L2蛋白阳性率为14.7%(10/68),与是否结外转移有关(χ^2=6.772,P=0.009);p-AKT蛋白阳性率为61.8%(42/68),与年龄是否≥60岁(χ^2=6.227,P=0.013)、美国东部肿瘤协作组(ECOG)评分(χ^2=4.005,P=0.045)、B症状(χ^2=10.187,P=0.001)和治疗缓解率(χ^2=4.096,P=0.043)有关.单因素分析显示PD-L1蛋白阳性表达组总生存(OS)率及无进展生存(PFS)率低于阴性表达组(均P<0.05).非GCB亚型患者PD-L1蛋白阳性表达组的OS率及PFS率均低于阴性表达组(均P<0.05).p-AKT蛋白阳性表达组较阴性表达组有较差的OS率及PFS率(均P<0.05).相关性分析显示PD-L1蛋白表达与PD-L2、p-AKT蛋白表达相关(r=0.380,P=0.001;r=0.273,P=0.025),且PD-L1、p-AKT共表达提示预后更差(P<0.05).多因素分析显示PD-L1和p-AKT蛋白高表达均是DLBCL独立的预后危险因素(均P<0.05).结论 PD-L1和p-AKT蛋白表达可能参与了DLBCL的发生发展,阻断程序性死亡受体1(PD-1)及相关配体的通路或联合阻断可能为临床治疗带来更多希望.     

18F-FDG PET-CT显像在外周T细胞淋巴瘤预后评估中的应用

目的 探讨化疗中期及治疗后18F-FDG PET-CT显像对外周T细胞淋巴瘤(PTCL)患者预后评估的应用价值.方法 回顾性分析经病理活组织检查和免疫组织化学确诊的44例PTCL患者的18F-FDG PET-CT显像资料.27例患者在化疗中期(3个周期化疗)、35例患者在全部治疗结束后行PET-CT检查,应用无进展生存(PFS)期及总体生存(OS)期作为评价指标,进行预后评估.结果 化疗中期18F-FDG PET-CT显像结果阳性者16例,阴性者1 1例,阳性者和阴性者中位PFS期分别为8个月和30个月,2年PFS率分别为18.8％(3/16)和90.9％(10/11),差异有统计学意义(x2=13.092,P=0.000);中位OS期分别为14个月和39个月,3年OS率分别为12.5％(2/16)和63.6％(7/11),差异有统计学意义(x 2=7.386,P=0.007).治疗后18F-FDG PET-CT显像结果阳性患者14例,阴性患者21例,阳性者和阴性者中位PFS期分别为10个月和26个月,2年PFS率分别为7.1％(1/14)和76.2％(16/21),差异有统计学意义(x 2=15.574,P=0.000);中位OS期分别为22个月和38个月,3年OS率分别为14.3％(2/14)和57.1％(12/21),差异有统计学意义(x2=6.245,P=0.012).结论 化疗中期及治疗后PET-CT检查结果对PTCL患者疗效监测及预后判断具有重要意义.     

中期18F-FDG PET/CT检查对评估R-CHOP治疗弥漫性大B细胞淋巴瘤疗效和预后的价值

目的:探讨18F-氟代脱氧葡萄糖正电子发射型计算机断层显像/计算机体层成像（18F-FDG PET/CT）检查对弥漫大B细胞淋巴瘤（DLBCL）预后评估的价值。方法:分析治疗前及治疗中期接受18F-FDG PET/CT检查并经病理确诊的62例DLBCL患者的临床资料,通过Deauville评分、最大标准摄取值减少率（△SUVmax）及国际预后指数（IPI）分析患者的疗效。采用Kaplan-Meier法、Log-rank检验及多因素COX回归分析Deauville评分、△SUVmax及IPI评分与无进展生存时间(PFS)和总生存时间（OS）的关系。结果:62例患者随访时间为14～59个月,中位随访时间为42个月。受试者工作特征（ROC）曲线计算△SUVmax最佳分界点为64.2％,Deauville评分、△SUVmax评估DLBCL患者的敏感度和特异度分别为76.2%和65.0%、90.5%和75.0%。Deauville评分评估DLBCL患者疗效的准确度为85.5％,高于△SUVmax（72.6%）。生存曲线分析显示,Deauville评分4～5分、△SUVmax<64.2％及IPI评分3～5分与DLBCL患者PFS和OS低有关（P＜0.001）。多因素COX回归分析显示,Deauville评［HR（95%CI）=3.740（1.725～7.662）］分/［HR（95%CI）=2.850（1.647～6.314）］及IPI评分［HR（95%CI）=2.624（1.380～5.927）］/［HR（95%CI）=2.372（1.128～5.190）］是影响DLBCL患者PFS和OS的独立危险因素（P＜0.05）。结论:中期PET/CT显像对评估DLBCL患者的疗效及预后具有较好的价值。     

原发性骨淋巴瘤临床特点及预后分析

目的 探讨原发性骨淋巴瘤(PBL)的临床特点、疗效及其与预后相关的因素.方法 对郑州大学第一附属医院2012年1月至2016年2月收治的19例PBL患者资料进行回顾性分析,探讨其临床病理特征及预后影响因素.结果19例患者中,男性11例,女性8例,中位年龄51岁;主要发病部位为股骨(5例)和脊柱(5例);8例行放化疗联合治疗,11例行单纯化疗;总有效率89.5%,包括完全缓解12例,部分缓解5例.2年总生存(OS)率、无进展生存(PFS)率分别为61.0%、48.3%.其中15例原发性骨弥漫大B细胞淋巴瘤(PB-DLBCL)患者2年OS率、PFS率分别为59.2%、45.5%.单因素分析显示淋巴瘤国际预后指数(IPI)评分≤2分、无软组织侵犯、初治完全缓解为OS及PFS的有利预后因素,美国东部肿瘤研究组(ECOG)评分≤2分为OS的有利预后因素,联合利妥昔单抗治疗为PFS的有利预后因素.多因素分析提示IPI评分是OS的独立预后因素,软组织侵犯是PFS的独立预后因素.结论 IPI评分≤2分及软组织未侵犯的PB-DLBCL患者预后较好.应根据局部软组织侵犯情况,探讨更合适的IPI评分模型.     

Ⅰ/Ⅱ期韦氏环弥漫大B细胞淋巴瘤免疫化疗后放疗疗效观察

目的 评价免疫化疗后早期韦氏环弥漫大B细胞淋巴瘤(DLBCL)的预后因素及放疗价值。方法 回顾性分析2009-03-21-2017-05-16本院收治的60例Ⅰ/Ⅱ期韦氏环DLBCL患者临床资料。将患者分为放疗组(33例)和未放疗组(27例),均接受利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松(R-CHOP)方案的免疫化疗,放疗组在免疫化疗后接受累及野放疗(中位剂量：46 Gy)。生存分析采用Kaplan-Meier曲线描述并行log-rank检验,Cox比例风险模型分析影响预后的因素。结果 全组随访达5年者有46例,5年总生存(OS)率、无进展生存(PFS)率和局部区域控制(LRC)率分别为80.00%、67.95%和84.47%。单因素分析结果显示,Ann Arbor分期为Ⅱ期、美国东部肿瘤协作组(ECOG)评分≥2分、分期改良国际预后指数(smIPI)评分≥2分和未放疗是OS的预后不良因素,Ann Arbor分期为Ⅱ期、ECOG评分≥2分是PFS的预后不良因素,而放疗则是LRC的有利因素。多因素分析结果显示,与OS有关联的因素包括年龄(HR=3.660,95%CI:1.02...     

疗前FDG PET-CT代谢参数与食管癌放疗预后关系初步研究

目的 探讨基于FDG PET-CT显像所采集的影像获取食管癌原发灶代谢参数——SUV_max、MTV、TLG及PTL对判断食管癌放疗或放疗联合治疗患者预后价值。方法 选择2006—2012年在本院行PET-CT放疗定位的Ⅰ—Ⅳ期食管癌患者55例入组,分析患者性别、年龄、原发灶部位、TNM分期、SUV_max、MTV、TLG、PTL、治疗手段与预后的关系。利用ROC寻找SUV_max、MTV、TLG及PTL最佳界值,将其分为高、低值组。Kaplan-Meier法生存分析并Logrank法检验。结果 全组患者中位OS时间为19.1个月(95%CI为8.1~30.1),1、2、3、4年OS率分别为59%、45%、35%、26%。SUV_max、MTV、TLG、PT低值组(SUV_max<11.4、MTV<8.27cm³、TLG<35.21、PTL<5.8 cm)有更好的预后(P=0.002、0.021、0.044、0.000)。结论 疗前SUV_max、MTV、TLG、PTL对判断食管癌患者预后有一定价值,放疗前可根据这些参数对患者进行危险分层,从而制订个体化治疗方案来改善预后。     

诱导化疗联合放疗在早期结外NK/T细胞淋巴瘤的预后分析

目的 分析早期结外NK/T细胞淋巴瘤(ENKTCL)使用诱导化疗联合放疗的疗效及预后因素。方法 2003—2021年间贵州医科大学附属肿瘤医院收治287例早期ENKTCL患者,接受诱导化疗联合放疗的综合治疗,分析早期NKTCL的临床预后相关因素。Kaplan-Meier计算总生存(OS)、无进展生存(PFS)及log-rank法检验和单因素分析,Cox模型多因素分析。结果 全组5年OS、PFS分别为72.8%、68.9%;基于改良的Nomogram风险指数(NRI)预后模型分为低危组(0分)、中低危组(1分)、中高危组(2分)、高危组(3分)和极高危组(≥4分)的5年OS分别为95.6%、76.3%、69.5%、61.0%和23.3%(P<0.001),5年PFS分别为93,2%、69.8%、64.6%、60.2%和23.3%(P<0.001)。放疗剂量≥50Gy和<50Gy组5年OS分别为73.8%和65.9%(P=0.123),5年PFS分别为72.8%和45.3%(P=0.001)。诱导化疗近期疗效为CR、PR、SD、PD的5年OS分别为85.4%、74.0%、61.8%、28.5%(P<0.001),5年PFS分别为83.7%、66.8%、65.7%、27.4%(P<0.001)。单因素分析显示Ⅱ期、ECOG≥2分、超腔、放疗剂量<50Gy、诱导化疗近期疗效为5年OS及PFS的预后不良因素(均P<0.05),多因素分析显示超腔、ECOG≥2分、Ⅱ期为OS预后不良因素(均P<0.05),而超腔、ECOG≥2分为PFS的预后不良因素(均P<0.05)。结论 早期结外NK/T细胞淋巴瘤采用以诱导化疗联合足量放疗能取得较好疗效;对诱导化疗近期疗效能够达到完全缓解预后良好。     

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。     

乙型肝炎病毒感染与弥漫大B细胞淋巴瘤预后的相关性分析

目的探讨乙型肝炎病毒(HBV)感染与弥漫大B细胞淋巴瘤(DLBCL)预后的相关性。方法选取乙型肝炎表面抗原(HBsAg)阳性和HBsAg阴性的初治DLBCL患者各60例,均给予化疗,比较分析两组患者化疗期间的肝功能以及随访2年后的无进展生存时间(PFS)和总生存时间(OS)。结果 HBsAg阳性组和HBsAg阴性组患者化疗期间的肝功能损害发生率分别为66.0%和40.0%,差异有统计学意义(P<0.05)。HBsAg阳性组患者的PFS为(16.1±3.2)个月,PFS率为70.0%,OS率为85.0%;HBsAg阴性组患者的PFS为(17.3±4.1)个月,PFS率为73.0%,OS率为88.0%,两组差异无统计学意义(P>0.05)。结论 HBV感染与DLBCL患者的预后无关,但合并HBV感染会增加DLBCL患者在化疗期间肝功能损害的发生率。     

Predictive value of baseline 18F-FDG PET/CT and interim treatment response for the prognosis of patients with diffuse large B-cell lymphoma receiving R-CHOP chemotherapy

The present study aimed to investigate the prognostic value of baseline ¹⁸F-FDG PET/CT quantitative parameters and interim treatment response, and to assess whether the combination of these could improve the predictive efficacy in patients with diffuse large B-cell lymphoma (DLBCL) receiving R-CHOP chemotherapy. PET/CT images and clinical data of 64 patients with DLBCL who had undergone ¹⁸F-FDG PET/CT scan before and after 3 or 4 cycles of R-CHOP chemotherapy were retrospectively reviewed. The quantitative parameters including standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum diameter of the maximum lesion (Dmax) were measured on baseline PET/CT images. Cox proportional hazards model was used to evaluate the influence of baseline PET/CT parameters, clinical indicators and interim treatment response on prognosis. Survival analysis was performed using Kaplan-Meier method. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive efficacy of the combination of baseline PET/CT parameters and interim treatment response. Ann Arbor stage, International Prognostic Index (IPI), lactate dehydrogenase (LDH), necrosis, MTVmax, TLGmax, Dmax and interim treatment response showed association with 2-year progression-free survival (PFS, P<0.05). LDH, necrosis, MTVmax, MTVsum, TLGmax, TLGsum, Dmax and interim treatment response showed association with 2-year overall survival (OS, P<0.05). Ann Arbor stage, Dmax and interim treatment response were found to be independent predictors of 2-year PFS (P<0.05), while Dmax and interim treatment response were found to be independent predictors of 2-year OS (P<0.05). The PFS and OS curves of Dmax <5.7 cm group and Dmax ≥5.7 cm group, complete response (CR) group and non-CR group were significantly different, respectively (P<0.05). The baseline ¹⁸F-FDG PET/CT parameters and interim treatment response have important prognostic values in DLBCL patients who received R-CHOP chemotherapy. Combined application of Dmax and interim treatment response improved the predictive efficacy of 2-year PFS. It may be helpful to identify patients who are at high-risk of relapse and to guide early clinical intervention of these patients.     

Total lesion glycolysis in positron emission tomography is a better predictor of outcome than the International Prognostic Index for patients with diffuse large B cell lymphoma

BACKGROUND:

This study was undertaken to evaluate the prognostic value of quantitative metabolic parameters in [¹⁸F]2‐fluoro‐2‐deoxyglucose (FDG)‐positron emission tomography (PET) for diffuse large B cell lymphoma (DLBCL).

METHODS:

A total of 140 DLBCL patients underwent FDG‐PET scans before rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R‐CHOP) chemotherapy. The maximal standardized uptake value (SUV_max) and total lesion glycolysis (TLG) were calculated, with the margin thresholds as 25%, 50%, and 75% of SUV_max of all lesions. Treatment outcomes were compared between groups according to metabolic parameters and the International Prognostic Index (IPI).

RESULTS:

After a median follow‐up of 28.5 months (range, 5‐81 months), the 2‐year progression‐free survival (PFS) and overall survival (OS) were 83% and 87%, respectively. Among metabolic parameters, TLG at the threshold of 50% (TLG₅₀) was significantly associated with treatment outcomes. High TLG₅₀ values (>415.5) were associated with reduced survivals compared with low TLG₅₀ values (≤415.5) (2‐year PFS of 73% versus 92%, P = .007; and 2‐year OS of 81% versus 93%, P = .031). High IPI score (≥3) significantly reduced OS (2‐year OS of 79% versus 90%, P = .049). Ann Arbor stage III/IV adversely affected PFS (P = .013). However, high IPI score and Ann Arbor stage of III/V did not significantly shorten PFS (P = .200) and OS (P = .921), respectively. High TLG₅₀ values independently predicted survivals by multivariate analysis (hazard ratio = 4.4; 95% confidence interval = 1.5‐13.1; P = .008 for PFS and hazard ratio = 3.1; 95% confidence interval = 1.0‐9.6; P = .049 for OS).

CONCLUSIONS:

Combined assessment of volume and metabolism (ie, TLG) is predictive of survivals in DLBCL patients who are treated with R‐CHOP. Cancer 2013. © 2012 American Cancer Society.     

Prognostic models integrating quantitative parameters from baseline and interim positron emission computed tomography in patients with diffuse large B-cell lymphoma: post-hoc analysis from the SAKK38/07 clinical trial

Positron emission computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) enrolled in a prospective clinical trial were reviewed to test the impact of quantitative parameters from interim PET/CT scans on overall (OS) and progression-free (PFS) survival. We centrally reviewed baseline and interim PET/CT scans of 138 patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone given every 14 days (R-CHOP14) in the SAKK38/07 trial ( ClinicalTrial.gov identifier: NCT00544219). Cutoff values for maximum standardized uptake value (SUV_max), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and metabolic heterogeneity (MH) were defined by receiver operating characteristic analysis. Responses were scored using the Deauville scale (DS). Patients with DS 5 at interim PET/CT (defined by uptake >2 times higher than in normal liver) had worse PFS (P = 0.014) and OS (P < 0.0001). A SUV_max reduction (Δ) greater than 66% was associated with longer PFS (P = 0.0027) and OS (P < 0.0001). Elevated SUV_max, MTV, TLG, and MH at interim PET/CT also identified patients with poorer outcome. At multivariable analysis, ΔSUV_max and baseline MTV appeared independent outcome predictors. A prognostic model integrating ΔSUV_max and baseline MTV discriminated three risk groups with significantly (log-rank test for trend, P < 0.0001) different PFS and OS. Moreover, the integration of MH and clinical prognostic indices could further refine the prediction of OS. PET metrics-derived prognostic models perform better than the international indices alone. Integration of baseline and interim PET metrics identified poor-risk DLBCL patients who might benefit from alternative treatments.     

Pre-treatment Metabolic Tumor Volume and Total Lesion Glycolysis are Useful Prognostic Factors for Esophageal Squamous Cell Cancer Patients

Objectives: To study application of the maximum standardized uptake value (SUVmax), metabolic tumorvolume (MTV) and total lesion glycolysis (TLG) with 18F-FDG PET/CT for predicting prognosis of esophagealsquamous cell cancer (ESC) patients. Methods: Eighty-six patients with ESC staged from I to IV were prospectivelyenrolled. Cisplatin-based chemoradiotherapy (CCRT) or palliative chemoradiotherapy were the main treatmentmethods and none received surgery. 18F-FDG PET/CT scans were performed before the treatment. SUVmax,MTV, and TLG were measured for the primary esophageal lesion and regional lymph nodes. Receiver operatingcharacteristic curves (ROCs) were generated to calculate the P value of the predictive ability and the optimalthreshold. Results: MTV and TLG proved to be good indexes in the prediction of outcome for the ESC patients.An MTV value of 15.6 ml and a TLG value of 183.5 were optimal threshold to predict the overall survival (OS).The areas under the curve (AUC) for MTV and TLG were 0.74 and 0.70, respectively. Kaplan-Meier analysisshowed an MTV less than 15.6 ml and a TLG less than 183.5 to indicate good media survival time (p value <0.05).In the stage III-IV patient group, MTV could better predict the OS (P < 0.001), with a sensitivity and specificityof 0.80 and 0.67, respectively. Conclusions: Pre-treatment MTV and TLG are useful prognostic factors in nonsurgicalESC.     

Potential Impact of Atelectasis and Primary Tumor Glycolysis on F-18 FDG PET/CT on Survival in Lung Cancer Patients

Background: Atelectasis is an important prognostic factor that can cause pleuritic chest pain, coughing ordyspnea, and even may be a cause of death. In this study, we aimed to investigate the potential impact of atelectasisand PET parameters on survival and the relation between atelectasis and PET parameters. Materials andMethods: The study consisted of patients with lung cancer with or without atelectasis who underwent 18F-FDGPET/CT examination before receiving any treatment. 18F-FDG PET/CT derived parameters including tumorsize, SUVmax, SUVmean, MTV, total lesion glycosis (TLG), SUV mean of atelectasis area, atelectasis volume,and histological and TNM stage were considered as potential prognostic factors for overall survival. Results:Fifty consecutive lung cancer patients (22 patients with atelectasis and 28 patients without atelectasis, medianage of 65 years) were evaluated in the present study. There was no relationship between tumor size and presenceor absence of atelectasis, nor between presence/absence of atelectasis and TLG of primary tumors. The overallone-year survival rate was 83% and median survival was 20 months (n=22) in the presence of atelectasis; theoverall one-year survival rate was 65.7% (n=28) and median survival was 16 months (p=0.138) in the absenceof atelectasis. With respect to PFS; the one-year survival rate of AT+ patients was 81.8% and median survivalwas 19 months; the one-year survival rate of AT- patients was 64.3% and median survival was 16 months(p=0.159). According to univariate analysis, MTV, TLG and tumor size were significant risk factors for PFS andOS (p<0.05). However, SUVmax was not a significant factor for PFS and OS (p>0.05). Conclusions: The presentstudy suggested that total lesion glycolysis and metabolic tumor volume were important predictors of survivalin lung cancer patients, in contrast to SUVmax. In addition, having a segmental lung atelectasis seems not to bea significant factor on survival.     

非霍奇金淋巴瘤中侵袭性淋巴瘤和惰性淋巴瘤的18F-FDG PET/CT显像特征

目的:分析非霍奇金淋巴瘤（non-Hodgkin's lymphoma,NHL）中侵袭性淋巴瘤和惰性淋巴瘤的临床病理参数和18F-FDG PET/CT代谢参数的差异,探讨18F-FDG PET/CT代谢参数对预测侵袭性和惰性淋巴瘤的价值。方法:回顾性分析2011年9月至2016年12月于哈尔滨医科大学附属肿瘤医院行18F-FDG PET/CT检查的66例淋巴瘤患者,记录患者的年龄、性别、是否发热、浅表及深部淋巴结受侵、结外侵犯、临床分期及PET/CT代谢参数［包括:最大标准化摄取值（maximum standardized uptake value,SUVmax）、肿瘤/纵隔血池比值（tumor SUVmax value/mediastinal SUVmax value,T/MB）、总糖酵解量（total lesion glycolysis,TLG）、肿瘤代谢体积（metabolic tumor volume,MTV）］,分析以上各因素在侵袭性淋巴瘤与惰性淋巴瘤之间的差异,绘制PET/CT代谢参数诊断侵袭性淋巴瘤和惰性淋巴瘤的ROC曲线,并计算诊断效能。结果:侵袭性淋巴瘤和惰性淋巴瘤的年龄、性别、发热、浅表淋巴结侵犯、临床分期无统计学差异（P>0.05）,而二者的深部淋巴结侵犯、结外受侵存在统计学差异（P<0.05）。侵袭性淋巴瘤的SUVmax、T/MB、TLG较惰性淋巴瘤高（P<0.05）。ROC曲线统计结果表明,SUVmax、T/MB、TLG分别以11.49、3.45、29.44为截断点时诊断侵袭性和惰性淋巴瘤的效能最佳,灵敏度分别为75%、80.4%、67.9%;特异度分别为90%、90%、70%。结论:侵袭性淋巴瘤的SUVmax、T/MB和TLG显著高于惰性淋巴瘤,在分析诊断淋巴瘤侵袭性时,18F-FDG PET/CT各参数具有重要参考价值,可为临床决策提供依据。     

高龄弥漫大B细胞淋巴瘤患者的临床特征及预后分析

目的探讨高龄弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征和预后情况。方法回顾性分析2016年1月至2018年12月上海交通大学医学院附属第九人民医院收治的13例高龄(年龄≥75岁)DLBCL患者的临床病理资料,均接受了R-CHOP方案为基础的个体化治疗,观察其临床特征、治疗疗效及预后情况。结果高龄DLBCL患者的中位年龄82岁(范围:75～89岁);69.2%(9/13)的患者Ann Arbor分期为Ⅲ～Ⅳ期;84.6%(11/13)的患者ECOG评分≥2;46.2%(6/13)的患者存在多处淋巴结外器官受累;8例(61.5%)完成了3个周期以上的化疗,客观缓解率(ORR)为15.4%(2/13)。2年无进展生存率为23.1%,2年生存率为53.8%。61.5%(8/13)的患者出现了3级及以上中性粒细胞减少,30.8%(4/13)的患者出现了3级及以上血小板减少;76.9%(10/13)的患者出现了肺部感染。单因素预后分析显示,改良国际预后指数(IPI)评分高、RCHOP方案不足3个周期及合并多种基础疾病者生存率低(P<0.05)。结论高龄DLBCL患者往往表现为侵袭性强、不...     

早期鼻腔NK/T细胞淋巴瘤74例放化疗效果及预后因素分析

目的 探讨早期鼻腔NK/T细胞淋巴瘤患者放化疗效果和预后因素.方法 回顾性分析2005年1月至2013年11月在山西省肿瘤医院接受治疗的确诊为ⅠE~ⅡE期的鼻腔NK/T细胞淋巴瘤患者74例,其中,单纯放疗28例,单纯化疗36例,同步放化疗10例.36例单纯化疗患者中,25例采用CHOP方案(环磷酰胺+多柔比星+长春新碱+泼尼松),4例采用DICE方案(地塞米松+异环磷酰胺+顺铂+依托泊苷),7例采用左旋门冬酰胺酶+地塞米松+异环磷酰胺+甲氨蝶呤+依托泊苷方案.Ann Arbor分期:Ⅰ期60例,Ⅱ期14例.采用Kaplan-Meier法进行生存分析,比较采用log-rank法,多因素分析采用Cox比例风险模型.结果 74例患者均完成治疗.全组失访10例,死亡24例.全组患者3年生存率72.5%,其中,单纯放疗组为92.7%,单纯化疗组为62.3%,同步放化疗组为79.1%,单纯放疗组与单纯化疗组间差异有统计学意义(χ2=10.676,P<0.05),单纯放疗组与同步放化疗组间差异无统计学意义(χ2=2.019,P>0.05).接受单纯放疗患者完全缓解率、部分缓解率、病情稳定率、进展率分别为89.3%(25/28)、7.1%(2/28)、3.6%(1/28)、0,接受单纯化疗的患者分别为55.6%(20/36)、25.0%(9/36)、8.0%(3/36)、11.1%(4/36),接受同步放化疗的患者分别为80.0%(8/10)、10.0%(1/10)、0、10.0%(1/10);单纯放疗组完全缓解率与单纯化疗组差异有统计学意义(χ2=8.584,P<0.05),单纯放疗组与同步放化疗组差异无统计学意义(χ2=0.556,P>0.05).单因素分析显示:年龄、美国东部肿瘤协作组(ECOG)评分、B症状、Ann Arbor分期、国际预后指数(IPI)及治疗方法的选择与预后有关.多因素分析结果显示,年龄、ECOG评分及Ann Arbor分期是独立的预后因素(均P<0.05).结论 放疗作为早期鼻腔NK/T细胞淋巴瘤的主要治疗手段,能取得较好的近期和远期疗效.年龄、ECOG评分、B症状、Ann Arbor分期、IPI及治疗方法与生存预后有关,年龄、ECOG评分及Ann Arbor分期是独立预后因素.     

Clinical impact of controlling nutritional status score on the prognosis of patients with diffuse large B-cell lymphoma

The controlling nutritional status (CONUT) score is a nutritional index calculated from serum albumin and total cholesterol levels and lymphocyte counts. Its role in predicting clinical outcomes of diffuse large B-cell lymphoma (DLBCL) has not been evaluated. In this retrospective study, data from 476 patients with DLBCL were analyzed. The cutoff value of the CONUT score was set as 4. CONUT score significantly stratified the overall survival (OS) and the progression-free-survival (PFS) (5-year OS, 49.0% vs 83.2%, P < .001; 5-year PFS, 46.1% vs 73.1%, P < .001) of the patients. Among patients at high-intermediate or high risk, as per the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI), 5-year OS was lower in patients with high CONUT scores than in those with low CONUT scores (high-intermediate risk, 51.2% vs 75.5%, P < .001; high risk, 29.9% vs 63.3%, P = .007). Additionally, in patients with high CONUT scores, maintenance of relative dose intensity (RDI) of chemotherapy did not affect the 5-year OS (RDI > 80% vs RDI ≤ 80%: 59.8% vs 50.9%, P = .73). In the present study, we have demonstrated that the CONUT score is an independent prognostic factor in patients with DLBCL.     

High expression of cell division cycle 7 protein correlates with poor prognosis in patients with diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is the most common form of lymphoma. According to the clinical risk factors and biological heterogeneity, clinical outcome of DLBCL is extremely various, with 5-year survival rates between 30 and 80?%. Although the International Prognostic Index (IPI) remains the primary clinical tool used to predict outcome for patients with DLBCL, notable variability in outcome is still observed within the same IPI score. The cell division cycle 7 (CDC7) is a serine?Cthreonine kinase, which is required to initiate DNA replication. Study showed that high expression of CDC7 was correlated with poor prognosis in patients with DLBCL. Whether CDC7 is an independent prognostic factor for DLBCL remains debatable. We studied the expression of CDC7 protein in 60 Chinese DLBCL patients with immunohistochemical analysis, 34 patients (56.7?%) categorized as low CDC7 expression and 26 patients (43.3?%) as high CDC7 expression. The median survival time of patients with low CDC7 expression was not achieved and that of high expression was 9?months (P?=?0.027). A multivariate analysis showed that IPI score and Ann Arbor stage were independent prognostic factors in relation to patients?? OS (P?<?0.05). Pearson correlation analysis showed that CDC7 expression level was positively correlated with IPI score and Ann Arbor stage (P?<?0.001). The results suggest that CDC7 expression level in combination with IPI score and Ann Arbor stage can be specific prognostic factors for DLBCL patients. CDC7 could also be a potential therapeutic target in DLBCL, especially for ABC-DLBCL.