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尽管国内滤泡性淋巴瘤(follicular lymphoma,FL)的发病率明显低于欧美国家,但随着诊疗水平的进步,FL的确诊率正呈逐年上升趋势[1]。病理分级为1~3a级的FL进展缓慢,属侵袭性较低的低级别FL;而3b级FL的临床表现及生物学特性与弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)相似,且可以向更高级别转化,属侵袭性较高的高级别FL。高级别FL与低级别FL的治疗策略相差较大,临床上需对FL的侵袭性进行评价[2-3]。目前FL的治疗方法以全身化疗为主,而化疗中期疗效是选择后续治疗方案的重要参考。因此,对FL侵袭性进行准确评估以及了解基线18F-FDG PET/CT检查与中期疗效的相关性对于FL的诊疗非常重要。
18F-FDG PET/CT作为基于糖代谢显像的全身性检查手段,在DLBCL等淋巴瘤亚型的诊治中的应用日益广泛,其有效性逐渐被临床证实和认可[4-7],18F-FDG PET/CT在FL诊疗中的应用也被国内外指南所推荐[8-9]。笔者主要探讨18F-FDG PET/CT基线SUVmax在初诊FL患者侵袭性评价中的价值及其与化疗中期疗效的相关性。
18F-FDG PET/CT基线SUVmax在滤泡性淋巴瘤侵袭性、分期评价中的价值及其与中期疗效的相关性研究
Evaluation of invasiveness, staging, and correlation with interim therapeutic response based on baseline 18F-FDG PET/CT SUVmax in patients with follicular lymphoma
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摘要:
目的探讨18F-FDG PET/CT基线最大标准化摄取值(SUVmax)在评估滤泡性淋巴瘤(FL)侵袭性、临床分期中的应用价值及其与R-CHOP(利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松)化疗方案中期疗效的相关性。 方法回顾性研究R-CHOP方案化疗前行基线18F-FDG PET/CT检查的FL患者48例,其中18例患者在3个周期R-CHOP化疗后再次行18F-FDG PET/CT检查进行疗效评估。应用两个独立样本t检验和Mann-Whitney U检验评价低级别FL组(病理分级为1~2级、3a级)与高级别FL组(病理分级为3b级及以上)、局限期组与播散期组、完全缓解组与非完全缓解组患者的基线SUVmax差异;应用Spearman相关分析评价基线SUVmax与不同Ann Arbor分期的相关性。 结果低级别FL组与高级别FL组患者的基线SUVmax差异有统计学意义(6.23±4.68 vs.13.20±6.68,t=3.919,P<0.001),受试者工作特征曲线(ROC)下面积为0.835。基线SUVmax与Ann Arbor分期无显著相关性(r=0.242,P=0.098)。低级别FL患者中局限期组的基线SUVmax明显低于播散期组,差异有统计学意义(中位数1.20 vs.7.85,U=24.000,P<0.001),ROC曲线下面积为0.905。R-CHOP中期化疗后疗效完全缓解组的基线SUVmax明显低于非完全缓解组,差异有统计学意义(5.16±3.05 vs.10.99±7.45,t=2.172,P=0.045)。 结论18F-FDG PET/CT基线SUVmax可有效评估FL的侵袭性,并与R-CHOP方案的中期疗效、低级别FL患者的病变播散程度密切相关。 -
关键词:
- 正电子发射断层显像术 /
- 体层摄影术, X线计算机 /
- 标准化摄取值 /
- 疗效评价 /
- 滤泡性淋巴瘤
Abstract:ObjectiveTo study the value of baseline 18F-FDG PET/CT maximum standardized uptake value (SUVmax) in evaluating the invasiveness, staging, and correlation between baseline SUVmax and the interim therapeutic response in patients with follicular lymphoma (FL). MethodsForty-eight FL patients who underwent baseline 18F-FDG PET/CT scan before chemotherapy, with the combination regimen of rituximab, cyclophosphamide, hydroxydaunomycin, oncovin and prednisolone (R-CHOP), were studied. Eighteen patients underwent 18F-FDG PET/CT scan again after 3 cycles of R-CHOP treatment to evaluate the interim therapeutic response. Two-sample t-test and Mann-Whitney U test were used to evaluate the differences in the baseline SUVmax between the following:low-grade group (pathological grades 1-2 and 3a) and high-grade group (pathological grade not lower than grade 3b); non-disseminated stage group and disseminated stage group; and complete response (CR) group and non-CR group. Spearman's rank correlation coefficient was used to estimate the relation between the baseline SUVmax and the Ann Arbor staging. ResultsThe baseline SUVmax was significantly different between the low-and high-grade groups (6.23±4.68 vs. 13.20±6.68, t=3.919, P<0.001), and the area under the receiver operating characteristic curve (AUC) was 0.835. No significant relation was found between the baseline SUVmax and the Ann Arbor staging (r=0.242, P=0.098). The baseline SUVmax of the non-disseminated stage group was significantly lower than that of the disseminated stage group among low-grade FL patients (median:1.20 vs. 7.85, U=24.000, P<0.001), and the AUC was 0.905. The baseline SUVmax of the CR group was significantly lower than that of the non-CR group after the interim R-CHOP therapy (5.16±3.05 vs. 10.99±7.45, t=2.172, P=0.045). ConclusionsThe baseline 18F-FDG PET/CT SUVmax is effective in evaluating invasiveness and staging and is related to the interim therapeutic response among FL patients. Moreover, the baseline SUVmax is related to the disease dissemination among low-grade FL patients. -
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