氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示的肿瘤坏死是弥漫性大B细胞淋巴瘤预后的独立预测指标。
Tumor necrosis at FDG-PET is an independent predictor of outcome in diffuse large B-cell lymphoma.
作者信息
Adams Hugo J A, de Klerk John M H, Fijnheer Rob, Heggelman Ben G F, Dubois Stefan V, Nievelstein Rutger A J, Kwee Thomas C
机构信息
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands.
出版信息
Eur J Radiol. 2016 Jan;85(1):304-309. doi: 10.1016/j.ejrad.2015.09.016. Epub 2015 Sep 21.
PURPOSE
To determine the prognostic performance of tumor necrosis at FDG-PET in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who are treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy.
MATERIALS AND METHODS
108 patients with newly diagnosed DLBCL who underwent FDG-PET before R-CHOP therapy were retrospectively included. Lymphomatous sites at FDG-PET were assessed for the presence of a photopenic area, in keeping with tumor necrosis. Univariate and multivariate Cox regression analyses were performed to determine the associations of tumor necrosis and National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) with progression-free survival (PFS) and overall survival (OS).
RESULTS
On univariate Cox regression analysis, both tumor necrosis and higher NCCN-IPI risk groups were significantly associated with PFS (P=0.024 and P<0.001, respectively) and OS (P=0.034 and P<0.001, respectively). On multivariate Cox regression analysis, both tumor necrosis and the NCCN-IPI were independent significant predictors for PFS (P=0.007, hazard ratio: 2.723 [95% confidence interval: 1.324-5.597] and P<0.001, hazard ratio: 2.952 [95% confidence interval: 1.876-4.646], respectively) and OS (P=0.009, hazard ratio: 2.794 [95% confidence interval: 1.305-5.985] and P<0.001, hazard ratio: 2.813 [95% confidence interval: 1.724-4.587], respectively).
CONCLUSION
Tumor necrosis at FDG-PET is an NCCN-IPI-independent predictor of outcome in DLBCL.
目的
确定接受利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗的新诊断弥漫性大B细胞淋巴瘤（DLBCL）患者中，FDG-PET检查时肿瘤坏死情况的预后价值。
材料与方法
回顾性纳入108例新诊断的DLBCL患者，这些患者在接受R-CHOP治疗前接受了FDG-PET检查。评估FDG-PET检查时淋巴瘤部位是否存在符合肿瘤坏死的放射性缺损区。进行单因素和多因素Cox回归分析，以确定肿瘤坏死和美国国立综合癌症网络国际预后指数（NCCN-IPI）与无进展生存期（PFS）和总生存期（OS）之间的关联。
结果
单因素Cox回归分析显示，肿瘤坏死和较高的NCCN-IPI风险组均与PFS（分别为P=0.024和P<0.001）和OS（分别为P=0.034和P<0.001）显著相关。多因素Cox回归分析显示，肿瘤坏死和NCCN-IPI均是PFS（分别为P=0.007，风险比：2.723 [95%置信区间：1.324-5.597]和P<0.001，风险比：2.952 [95%置信区间：1.876-4.646]）和OS（分别为P=0.009，风险比：2.794 [95%置信区间：1.305-5.985]和P<0.001，风险比：2.813 [95%置信区间：1.724-4.587]）的独立显著预测因素。
结论
FDG-PET检查时的肿瘤坏死是DLBCL中NCCN-IPI独立的预后预测因素。
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