Lin Chieh, Itti Emmanuel, Haioun Corinne, Petegnief Yolande, Luciani Alain, Dupuis Jehan, Paone Gaetano, Talbot Jean-Noël, Rahmouni Alain, Meignan Michel
Department of Radiology, H. Mondor Hospital, AP-HP/Paris 12 University, Créteil, France.
J Nucl Med. 2007 Oct;48(10):1626-32. doi: 10.2967/jnumed.107.042093. Epub 2007 Sep 14.
The purpose of this study was to assess the prognostic value of early (18)F-FDG PET using standardized uptake value (SUV) compared with visual analysis in patients with diffuse large B-cell lymphoma (DLBCL).
Ninety-two patients with newly diagnosed DLBCL underwent (18)F-FDG PET prospectively before and after 2 cycles of chemotherapy (at midtherapy). Maximum SUV (SUVmax) and mean SUV (SUVmean) normalized to body weight and body surface area, as well as tumor-to-normal ratios, were computed on the most intense uptake areas. The SUVs, tumor-to-normal ratios, and their changes over time were compared with visual analysis for predicting event-free survival (EFS) and overall survival, using receiver-operating-characteristic (ROC) analysis. Survival curves were estimated with Kaplan-Meier analysis and compared using the log-rank test.
With visual analysis, the accuracy of early PET to predict EFS was 65.2%. The 2-y estimate for EFS was 51% (95% confidence interval [CI], 34%-68%) in the PET-positive group compared with 79% (95% CI, 68%-90%) in the PET-negative group (P = 0.009). An optimal cutoff value of 65.7% SUVmax reduction from baseline to midtherapy obtained from ROC analysis yielded an accuracy of 76.1% to predict EFS. The 2-y estimate for EFS was 21% (95% CI, 0%-42%) in patients with SUVmax reduction <or= 65.7% compared with 79% (95% CI, 69%-88%) in those with reduction > 65.7% (P < 0.0001). Fourteen patients considered as positive on visual analysis could have been reclassified as good responders.
SUV-based assessment of therapeutic response during first-line chemotherapy improves the prognostic value of early (18)F-FDG PET compared with visual analysis in DLBCL.
本研究的目的是评估在弥漫性大B细胞淋巴瘤（DLBCL）患者中，与视觉分析相比，使用标准化摄取值（SUV）进行早期（18）F-FDG PET检查的预后价值。
92例新诊断的DLBCL患者在化疗2个周期前后（化疗中期）前瞻性地接受了（18）F-FDG PET检查。计算了在摄取最强烈区域的最大SUV（SUVmax）、平均SUV（SUVmean），并将其归一化至体重和体表面积，以及肿瘤与正常组织的比值。使用受试者操作特征（ROC）分析，将SUV值、肿瘤与正常组织的比值及其随时间的变化与视觉分析进行比较，以预测无事件生存期（EFS）和总生存期。采用Kaplan-Meier分析估计生存曲线，并使用对数秩检验进行比较。
通过视觉分析，早期PET预测EFS的准确性为65.2%。PET阳性组的2年EFS估计值为51%（95%置信区间[CI]，34%-68%），而PET阴性组为79%（95%CI，68%-90%）（P = 0.009）。从ROC分析得出，从基线到化疗中期SUVmax降低的最佳临界值为65.7%，其预测EFS的准确性为76.1%。SUVmax降低≤65.7%的患者2年EFS估计值为21%（95%CI，0%-42%），而降低>65.7%的患者为79%（95%CI，69%-88%）（P < 0.0001）。14例在视觉分析中被视为阳性的患者可能被重新分类为良好反应者。
与视觉分析相比，在DLBCL中基于SUV评估一线化疗期间的治疗反应可提高早期（18）F-FDG PET的预后价值。
