18F-FDG PET/CT RECIL与Lugano标准对弥漫大B细胞淋巴瘤中期疗效与预后评估的价值

Value of response evaluation criteria in lymphoma and Lugano classification of 18F-FDG PET/CT for the mid-term therapeutic and prognostic evaluation in diffuse large B-cell lymphoma

    摘要
  • 摘要:
    目的  探讨18F-氟脱氧葡萄糖（FDG） PET/CT淋巴瘤疗效评价标准（RECIL）与Lugano标准对弥漫大B细胞淋巴瘤（DLBCL）中期疗效与预后评估的价值。
    方法 回顾性分析2008年1月至2020年12月于上海交通大学医学院附属第一人民医院经组织病理学检查证实为DLBCL且在治疗前及中期（3~4个疗程）化疗后行18F-FDG PET/CT检查的82例患者的临床资料和影像资料，其中男性40例、女性42例，年龄（53.9±16.6）岁。依据RECIL在中期化疗后对所有患者进行疗效评价，包括完全缓解（CR）、部分缓解（PR）、轻微缓解（MR）、疾病稳定（SD）、疾病进展（PD），将MR患者分别定义为PR或SD。再依据Lugano标准在中期化疗后对所有患者进行疗效评价，包括CR、PR、SD、PD。CR和PR患者归为缓解组，SD和PD患者归为未缓解组。采用Kappa检验比较RECIL和Lugano标准的一致性；采用Kaplan-Meier生存分析比较RECIL和Lugano标准缓解组与未缓解组患者的预后；采用Log-rank检验比较RECIL和Lugano标准的组间差异；采用单因素、多因素Cox比例风险回归分析筛选影响患者预后的因素。
    结果 当MR患者定义为PR时，RECIL与Lugano标准的一致性为92.7%（76/82），一致性较好（Kappa值=0.855，P<0.01）。当MR患者定义为SD时，二者的一致性为90.2%（74/82），一致性也较好（Kappa值=0.811，P<0.01）。Lugano标准、RECIL（MR定义为PR）、RECIL（MR定义为SD）缓解组患者的2年无进展生存（PFS）率（69.7% 对 0、71.4% 对 0、71.2%对0）和总生存（OS）率（88.2% 对33.3%，87.0% 对40.0%，90.4%对33.3%）均明显高于未缓解组，且差异均有统计学意义（χ2=14.540~65.446，均P<0.01）。多因素Cox比例风险回归分析显示，年龄、RECIL（MR患者定义为SD）均是影响DLBCL患者中期治疗后PFS率的危险因素风险比（HR）=1.050、3.527，均P<0.001，RECIL未缓解组患者进展的风险是缓解组患者的3.527倍。年龄、Ann Arbor分期、RECIL（MR患者定义为SD）均是影响DLBCL患者中期治疗后OS率的危险因素（HR=1.097、1.884、4.739，均P<0.05），RECIL未缓解组患者死亡的风险是缓解组患者的4.739倍。
    结论 RECIL与Lugano标准对DLBCL患者中期治疗后疗效评估的一致性较好，RECIL能在DLBCL患者的预后预测中提供有价值的信息。

     

    Abstract:
    Objective To discuss the value of the response evaluation criteria in lymphoma (RECIL) and Lugano classification of 18F-fluorodeoxyglucose (FDG) PET/CT for the mid-term therapeutic and prognostic evaluation of diffuse large B-cell lymphoma (DLBCL).
    Methods Clinical and imaging data of 82 patients with DLBCL (40 males and 42 females, aged (53.9±16.6) years) confirmed by histopathological examiation in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January 2008 to December 2020 were retrospectively analyzed. 18F-FDG PET/CT was performed before treatment and after three or four courses of chemotherapy. In accordance with RECIL, all patients were evaluated for efficacy after mid-term chemotherapy, including complete remission (CR), partial remission (PR), minor response (MR), stable disease (SD), and progressive disease (PD). MR patients were recoded as PR and SD separately. Then, the Lugano classification was used after mid-term chemotherapy, including CR, PR, SD, and PD. CR and PR were classified as the remission group, and SD and PD were classified as the non-remission group. Kappa test was used to evaluate the consistency of efficacy between the RECIL and Lugano classification. Kaplan-Meier survival analysis was performed to compare the prognosis of patients of remission group and non-remission group on the basis of RECIL and Lugano classification. The intergroup differences between RECIL and Lugano classification were compared using Log-rank test. Univariate and multivariate Cox proportional risk regression analyses were performed to screen for factors affecting prognosis.
    Results When MR patients were recoded as PR, the RECIL and Lugano classification showed consistency in the efficacy for evaluating patients after mid-term chemotherapy (92.7% (76/82), Kappa=0.855, P<0.01). When MR patients were recoded as SD, the consistency between RECIL and Lugano classification was 90.2%(74/82) (Kappa=0.811, P<0.01), which was considered as good. The 2-year progression-free survival (PFS) rates (69.7% vs. 0, 71.4% vs. 0, 71.2% vs. 0) and overall survival (OS) rates (88.2% vs. 33.3%, 87.0% vs. 40.0%, 90.4% vs. 33.3%) of the remission group in the Lugano classification and RECIL (MR recoded as PR and SD separately) were significantly higher than those of the non-remission group (χ2=14.540−65.446, all P<0.01). Multivariate Cox proportional risk regression analysis showed that age and RECIL (MR recoded as SD) were factors for the PFS rate of DLBCL (hazard ratio (HR)=1.050, 3.527; both P<0.001). The risk of progression for patients in the RECIL non-remission group was 3.527 times higher than that in the remission group. Multivariate Cox proportional risk regression analysis also showed that age, Ann Arbor stage, and RECIL(MR recorded as SD) were factors for the OS rate of DLBCL (HR=1.097, 1.884, 4.739; all P<0.05). The risk of death for patients in the RECIL non-remission group was 4.739 times higher than that in the remission group.
    Conclusions The consistency between RECIL and Lugano classification after mid-term chemotherapy evaluation of DLBCL patients is good. RECIL can provide valuable information in predicting the prognosis of DLBCL patients.

     

    • HTML全文
    • 参考文献(11)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回