18F-FDG PET/CT对化疗中期弥漫性大B细胞淋巴瘤患者预后判断的价值

The value of 18F-FDG PET/CT in predicting the prognosis of patients with diffuse large B-cell lymphoma in the middle stage of chemotherapy

    摘要
  • 摘要:
    目的 探讨18F-氟脱氧葡萄糖（FDG）PET/CT参数对化疗中期弥漫性大B细胞淋巴瘤（DLBCL）患者预后判断的价值。
    方法 回顾性分析2011年1月至2020年1月河北医科大学第四医院112例DLBCL患者的临床资料和化疗3~4周期后（中期）18F-FDG PET/CT显像资料，其中男性60例、女性52例，年龄16~79（49.5±16.6）岁。以最大标准化摄取值（SUVmax）的40%为阈值勾画感兴趣区（ROI），获得病灶的SUVmax、全身所有病灶总的代谢肿瘤体积（TMTV）、总的糖酵解总量（TTLG），在CT图像上测量6个靶病灶的最大垂直径乘积之和（SPD）。采用受试者工作特性（ROC）曲线计算各代谢参数和解剖测量参数预测患者无进展生存（PFS）期和总生存（OS）期的最佳临界值。采用Kaplan-Meier法进行生存分析，采用Log-rank检验进行单因素分析，采用Cox比例风险回归模型对单因素分析有统计学意义的预后影响因素进行多因素分析。
    结果 112例DLBCL患者中，在随访期间25例（22.3%）出现疾病进展、14例（12.5%）死亡。18F-FDG PET/CT 参数SUVmax、TMTV、TTLG和SPD预测DLBCL患者PFS期的最佳临界值分别为1.75、6.40 cm3、9.30 g和3.53 cm2，曲线下面积（AUC）分别为0.712、0.652、0.680、0.728（95%CI：0.596~0.829、0.518~0.787、0.549~0.811、0.619~0.837，均P<0.05）；预测OS期的最佳临界值分别为3.75、17.80 cm3、19.05 g和5.67 cm2，AUC分别为0.727、0.686、0.727、0.757（95%CI：0.578~0.877、0.512~0.861、0.559~0.896、0.622~0.891，均P<0.05）。单因素分析结果显示，年龄、美国东部肿瘤协作组（ECOG）评分、国际预后指数评分、美国国家综合癌症网络-国际预后指数评分、Deauville评分以及SUVmax、TMTV、TTLG、SPD均是DLBCL患者PFS期（χ2=5.152~22.998，均P<0.05）和OS期的影响因素（χ2=4.735~19.687，均P<0.05）；乳酸脱氢酶（LDH）水平是OS期的影响因素（χ2=4.154，P<0.05），但不是PFS期的影响因素（χ2=2.223，P>0.05）。多因素分析结果显示，年龄、ECOG评分、TTLG是影响DLBCL患者PFS期的独立危险因素（HR=0.331、0.262、0.281，95%CI：0.145~0.753、0.113~0.605、0.119~0.666，均P<0.01）；LDH水平、SPD是影响DLBCL患者OS期的独立危险因素（HR=0.594、1.922，95%CI：0.360~0.979、1.123~3.290，均P<0.05）。
    结论 18F-FDG PET/CT参数 SUVmax、TMTV、TTLG、SPD对化疗中期DLBCL患者预后有较好的判断价值。

     

    Abstract:
    Objective To investigate the prognostic value of 18F-fluorodeoxyglucose (FDG) PET/CT parameters in patients with diffuse large B-cell lymphoma (DLBCL) in their middle stage of chemotherapy.
    Methods Clinical data and PET/CT imaging data of 112 DLBCL patients in the Fourth Hospital of Hebei Medical University from January 2011 to January 2020 after 3–4 cycles of chemotherapy were retrospectively analyzed, patients included 60 males and 52 females aged 16–79 (49.5±16.6) years. Then, 40% of the maximum standardized uptake value (SUVmax) was taken as the threshold to outline the region of interest (ROI) and subsequently obtain the SUVmax of lesion, total metabolic tumor volume (TMTV), and total of total lesion glycolysis (TTLG) of all lesions in the body. The sum of products of greatest diameter (SPD) of six target lesions were measured on a CT image. The optimal cut-off values of predicting the progress-free survival (PFS) and overall survival (OS) of the metabolic parameters and anatomical measurement parameters were calculated using the receiver operating characteristic (ROC) curve. The Log-rank test was used for univariate analysis. Kaplan-Meier method was used for the survival analysis. Cox proportional hazards regression model was used for the multivariate analysis of statistically significant prognostic factors obtained from the univariate analysis.
    Results Among 112 patients, 25 (22.3%) disease developed DLBCL and 14 (12.5%) died from DLBCL during the follow-up period. The optimal cut-off values of the 18F-FDG PET/CT parameters for SUVmax, TMTV, TTLG, and SPD for predicting the PFS of patients with DLBCL were 1.75, 6.40 cm3, 9.30 g, and 3.53 cm2, respectively, with corresponding area under curve (AUC) of 0.712, 0.652, 0.680 and 0.728 (95% CI: 0.596–0.829, 0.518–0.787, 0.549–0.811 and 0.619–0.837; all P<0.05). Meanwhile, the optimal cut-off values for predicting OS were 3.75, 17.80 cm3, 19.05 g, and 5.67 cm2, respectively, with corresponding AUC of 0.727, 0.686, 0.727 and 0.757 (95% CI: 0.578–0.877, 0.512–0.861, 0.559–0.896 and 0.622–0.891; all P<0.05). The results of univariate analysis indicate that age, Eastern Cooperative Oncology Group (ECOG) score, International Prognostic Index (IPI) score, National Comprehensive Cancer Network-IPI score, Deauville score, SUVmax, TMTV, TTLG, and SPD were the influencing factors of PFS (χ2=5.152–22.998, all P<0.05) and OS (χ2=4.735–19.687, all P<0.05). Meanwhile, lactate dehydrogenase (LDH) level only influences OS (χ2=4.154, P<0.05) but not PFS (χ2=2.223, P>0.05). Then, the results of multivariate analysis indicate that age, ECOG score, and TTLG were the independent risk factors affecting the PFS of patients with DLBCL (HR=0.331, 0.262, and 0.281; 95% CI: 0.145–0.753, 0.113–0.605 and 0.119–0.666; all P<0.01), whereas LDH level and SPD were the independent risk factors affecting the OS patients with DLBCL (HR=0.594, 1.922; 95% CI: 0.360–0.979 and 1.123–3.290; all P<0.05).
    Conclusions The 18F-FDG PET/CT parameters of SUVmax, TMTV, TTLG, and SPD have a good prognostic value for DLBCL patients in their middle stage of chemotherapy.

     

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