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弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)是最常见的非霍奇金淋巴瘤,具有侵袭性较高、异质性较强和自然病程较短的特点。利妥昔单抗的出现改变了DLBCL患者的预后情况,但仍有20%~40%的患者预后欠佳。因此,及时评估患者对化疗的反应情况,早期识别预后较差的患者意义重大。
在过去的20年中,国际预后指数(international prognosis index,IPI)是评估DLBCL患者预后的常用指标,但IPI评分系统不能动态反映疾病的变化过程[1],因此其准确率受到了越来越多的质疑。近年来,PET/CT在淋巴瘤的诊断和治疗的各个方面已经成为一种重要的影像学检查手段,其不仅能提供PET功能显像图,还能结合CT提供的解剖学信息,将病灶的代谢水平和解剖细节进行融合,在残留病灶性质的鉴别方面较其他常规方法表现出明显的优势。鉴于目前大部分研究者认为,虽然PET/CT图像结果与DLBCL患者预后关系密切,但在图像评判方法上却没有一致的标准[2-4]。笔者对PET/CT不同评价体系在DLBCL患者预后评估中的应用价值进行综述。
PET/CT不同评价体系在弥漫性大B细胞淋巴瘤预后评估中的应用
Application of different PET/CT evaluation systems in the prognosis evaluation of diffuse large B-cell lymphoma
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摘要: 弥漫性大B细胞淋巴瘤(DLBCL)是发病率较高的淋巴造血系统疾病,该病进展较快、病死率较高。如何通过现有的检查技术精确地对患者进行预后评估是研究者们面临的一大难题。目前,PET/CT以其能同时提供解剖及功能图像的独特优势,广泛地应用于淋巴瘤的治疗监测及预后评估中,但采用哪种评价体系对图像进行判读的准确率更高仍存在较大争议。笔者综述了PET/CT定性、半定量及其他新的评价体系在DLBCL预后评估中的应用价值。
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关键词:
- 淋巴瘤, 大B细胞, 弥漫性 /
- 正电子发射断层显像计算机体层摄影术 /
- 预后评估
Abstract: Diffuse large B-cell lymphoma is a hematopoietic system disease with high incidence rate, rapid progression, and high mortality rate. Accurate prognosis evaluation through existing examination techniques is a major problem faced by scholars. At present, PET/CT has been widely used in the treatment monitoring and prognosis evaluation of lymphomas because of its unique advantage of simultaneously providing anatomical and functional images. However, a major controversy persists about which evaluation system provides accurate image assessment. This paper mainly introduces the application value of qualitative, semi-quantitative, and other new evaluation systems in the prognosis evaluation of diffuse large-B cell lymphoma. -
[1] Ngo L, Hee SW, Lim LC, et al. Prognostic factors in patients with diffuse large B cell lymphoma: Before and after the introduction of rituximab[J]. Leuk Lymphoma, 2008, 49(3): 462−469. DOI: 10.1080/10428190701809156. [2] Barrington SF, Johnson PWM. 18F-FDG PET/CT in Lymphoma: Has Imaging-Directed Personalized Medicine Become a Reality?[J]. J Nucl Med, 2017, 58(10): 1539−1544. DOI: 10.2967/jnumed.116.181347. [3] Zhang XY, Song L, Wang PJ, et al. Prognostic Value of Pre-Autologous Stem Cell Transplantation PET/CT in Diffuse Large B-Cell Lymphoma: The Deauville Score Is Prognostically Superior to ΔSUVmax[J]. Acta Haematol, 2019, 5: 1−7. DOI: 10.1159/000500512. [4] Winter A, Rybicki L, Shah SN, et al. Prognostic value of pre-transplant PET/CT in patients with diffuse large B-cell lymphoma undergoing autologous stem cell transplantation[J]. Leuk Lymphoma, 2018, 59(5): 1195−1201. DOI: 10.1080/10428194.2017.1369065. [5] Schöder H, Zelenetz AD, Hamlin P, et al. Prospective Study of 3'-Deoxy-3'-18F-Fluorothymidine PET for Early Interim Response Assessment in Advanced-Stage B-Cell Lymphoma[J]. J Nucl Med, 2016, 57(5): 728−734. DOI: 10.2967/jnumed.115.166769. [6] Safar V, Dupuis J, Itti E, et al. Interim [18F]Fluorodeoxyglucose Positron Emission Tomography Scan in Diffuse Large B-Cell Lymphoma Treated With Anthracycline-Based Chemotherapy Plus Rituximab[J]. J Clin Oncol, 2012, 30(2): 184−190. DOI: 10.1200/JCO.2011.38.2648. [7] Pregno P, Chiappella A, Bellò M, et al. Interim 18-FDG-PET/CT failed to predict the outcome in diffuse large B-cell lymphoma patients treated at the diagnosis with rituximab-CHOP[J]. Blood, 2012, 119(9): 2066−2073. DOI: 10.1182/blood−2011−06−359943. [8] Kim J, Song YS, Lee JS, et al. Risk stratification of diffuse large B-cell lymphoma with interim PET-CT based on different cutoff Deauville scores[J]. Leuk Lymphoma, 2018, 59(2): 340−347. DOI: 10.1080/10428194.2017.1339877. [9] Itti E, Meignan M, Berriolo-Riedinger A, et al. An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma: comparison between Deauville criteria and ΔSUVmax[J]. Eur J Nucl Med Mol Imaging, 2013, 40(9): 1312−1320. DOI: 10.1007/s00259−013−2435−6. [10] Nols N, Mounier N, Bouazza S, et al. Quantitative and qualitative analysis of metabolic response at interim positron emission tomography scan combined with International Prognostic Index is highly predictive of outcome in diffuse large B-cell lymphoma[J]. Leuk Lymphoma, 2014, 55(4): 773−780. DOI: 10.3109/10428194.2013.831848. [11] 范洋, 张玥伟, 杨志, 等. 化疗早期18F-FDGPET/CT评价弥漫性大B细胞淋巴瘤的疗效及预后预测[J]. 肿瘤, 2015, 35(9): 1013−1020. DOI: 10.3781/j.issn.1000−7431.2015.33.254.
Fan Y, Zhang YW, Yang Z, et al. Early 18F-FDG PET/CT in evaluation of chemotherapeutic response and prognostic prediction for patients with diffuse large B-cell lymphoma[J]. Tumor, 2015, 35(9): 1013−1020. DOI: 10.3781/j.issn.1000−7431.2015.33.254.[12] Zhang YY, Song L, Zhao MX, et al. A better prediction of progression-free survival in diffuse large B-cell lymphoma by a prognostic model consisting of baseline TLG and %ΔSUVmax[J]. Cancer Med, 2019, 8(11): 5137−5147. DOI: 10.1002/cam4.2284. [13] Li X, Sun X, Li J, et al. Interim PET/CT based on visual and semiquantitative analysis predicts survival in patients with diffuse large B-cell lymphoma[J]. Cancer Med, 2019, 8(11): 5012−5022. DOI: 10.1002/cam4.2404. [14] Mikhaeel NG, Smith D, Dunn JT, et al. Combination of baseline metabolic tumour volume and early response on PET/CT improves progression-free survival prediction in DLBCL[J]. Eur J Nucl Med Mol Imaging, 2016, 43(7): 1209−1219. DOI: 10.1007/s00259−016−3315−7. [15] Song MK, Yang DH, Lee GW, et al. High total metabolic tumor volume in PET/CT predicts worse prognosis in diffuse large B cell lymphoma patients with bone marrow involvement in rituximab era[J]. Leuk Res, 2016, 42: 1−6. DOI: 10.1016/j.leukres.2016.01.010. [16] Gallicchio R, Mansueto G, Simeon V, et al. F-18 FDG PET/CT quantization parameters as predictors of outcome in patients with diffuse large B-cell lymphoma[J]. Eur J Haematol, 2014, 92(5): 382−389. DOI: 10.1111/ejh.12268. [17] 辛仲宏, 张皓. 18F-FDG PET/CT肿瘤代谢负荷参数评估恶性肿瘤预后的价值[J]. 国际医学放射学杂志, 2018, 41(4): 459−463. DOI: 10.19300/j.2018.Z5140.
Xin ZH, Zhang H. Prognostic value of metabolic tumor burden parameters on 18F-FDG PET/CT in malignant tumor[J]. Int J Med Radiol, 2018, 41(4): 459−463. DOI: 10.19300/j.2018.Z5140.[18] Freudenberg LS, Antoch G, Schütt P, et al. FDG-PET/CT in re-staging of patients with lymphoma[J]. Eur J Nucl Med Mol Imaging, 2004, 31(3): 325−329. DOI: 10.1007/s00259−003−1375−y. [19] Zhou MG, Chen YM, Huang HH, et al. Prognostic value of total lesion glycolysis of baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography in diffuse large B-cell lymphoma[J/OL]. Oncotarget, 2016, 7(50): 83544−83553 [2019-01-03]. http://www.oncotarget.com/index.php?journal=oncotarget&page=article&op=view&path[]=13180&path[]=41778. DOI: 10.18632/oncotarget.13180. [20] Sasanelli M, Meignan M, Haioun C, et al. Pretherapy metabolic tumour volume is an independent predictor of outcome in patients with diffuse large B-cell lymphoma[J]. Eur J Nucl Med Mol Imaging, 2014, 41(11): 2017−2022. DOI: 10.1007/s00259−014−2822−7. [21] Alizadeh AA, Eisen MB, Davis RE, et al. Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling[J]. Nature, 2000, 403(6769): 503−511. DOI: 10.1038/35000501. [22] Toledano MN, Desbordes P, Banjar A, et al. Combination of baseline FDG PET/CT total metabolic tumour volume and gene expression profile have a robust predictive value in patients with diffuse large B-cell lymphoma[J]. Eur J Nucl Med Mol Imaging, 2018, 45(5): 680−688. DOI: 10.1007/s00259−017−3907−x. [23] Kwon SH, Kang DR, Kim J, et al. Prognostic value of negative interim 2-[18F]-fluoro-2-deoxy-d-glucose PET/CT in diffuse large B-cell lymphoma[J]. Clin Radiol, 2016, 71(3): 280−286. DOI: 10.1016/j.crad.2015.11.019. [24] de Oliveira Costa R, Hallack Neto A, Siqueira S, et al. Interim fluorine-18 fluorodeoxyglucose PET-computed tomography and cell of origin by immunohistochemistry predicts progression-free and overall survival in diffuse large B-cell lymphoma patients in the rituximab era[J]. Nucl Med Commun, 2016, 37(10): 1095−1101. DOI: 10.1097/MNM.0000000000000553. [25] Kim J, Lee JO, Paik JH, et al. Different predictive values of interim 18F-FDG PET/CT in germinal center like and non-germinal center like diffuse large B-cell lymphoma[J]. Ann Nucl Med, 2017, 31(1): 1−11. DOI: 10.1007/s12149−016−1123−6. [26] Jiang MQ, Chen P, Ruan XZ, et al. Interim 18F-FDG PET/CT and BCL2 for predicting the prognosis of patients with diffuse large B-cell lymphoma in the rituximab era[J]. Nucl Med Commun, 2018, 39(2): 147−153. DOI: 10.1097/MNM.0000000000000784. [27] Minamimoto R, Fayad L, Advani R, et al. Diffuse Large B-Cell Lymphoma: Prospective Multicenter Comparison of Early Interim FLT PET/CT versus FDG PET/CT with IHP, EORTC, Deauville, and PERCIST Criteria for Early Therapeutic Monitoring[J]. Radiology, 2016, 280(1): 220−229. DOI: 10.1148/radiol.2015150689. [28] Kong Y, Qu LL, Li YK, et al. Predictive Significance of a New Prognostic Score for Patients With Diffuse Large B-Cell Lymphoma in the Interim-Positron Emission Tomography Findings[J]. Medicine (Baltimore), 2016, 95(6): e2808. DOI: 10.1097/MD.0000000000002808. [29] Liu T, Chen L, Pan J, et al. Retrospective Analysis of a New Prognostic Score for Diffuse Large B-Cell Lymphoma Based on Interim Positron Emission Tomography-Computed Tomography[J]. Acta Haematol, 2018, 139(3): 148−157. DOI: 10.1159/000479486. [30] Fan Y, Zhang YW, Yang Z, et al. Evaluating early interim fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography with the SUVmax-liver-based interpretation for predicting the outcome in diffuse large B-cell lymphoma[J]. Leuk Lymphoma, 2017, 58(9): 2065−2073. DOI: 10.1080/10428194.2016.1277384. [31] Itti E, Juweid ME, Haioun C, et al. Improvement of Early 18F-FDG PET Interpretation in Diffuse Large B-Cell Lymphoma: Importance of the Reference Background[J]. J Nucl Med, 2010, 51(12): 1857−1862. DOI: 10.2967/jnumed.110.080556.
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