Kong Yu, Qu Lili, Li Yuekai, Liu Dai, Lv Xuemin, Han Jiankui
From the Department of Nuclear Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Medicine (Baltimore). 2016 Feb;95(6):e2808. doi: 10.1097/MD.0000000000002808.
We hypothesized that the objective treatment response of patients with diffuse large B-cell lymphoma (DLBCL) was affected by many factors such as pathophysiological, biological, and pharmaceutical mechanisms. This retrospective study aimed to evaluate the predictive significance of clinical prognostic factors and interim fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT), and to find a new prognostic predictor significantly associated with DLBCL patients' outcome. A total of 105 adult patients with DLBCL were reviewed. Each patient underwent an interim F-FDG PET/CT scan after the second chemotherapy cycle. The visual method based on the Deauville 5-point scale was used to evaluate the interim-PET/CT scans. The relationships among the prognostic factors, the 3-year progression-free survival (PFS) rate and overall survival (OS) rate were analyzed with Kaplan-Meier plots. The predictive value of the newly constructed prognostic score was analyzed with multivariate analysis (Cox proportional hazard regression model). The visual analysis showed statistically significant differences in both PFS and OS between the patients with a negative interim-PET/CT and those with a positive interim-PET/CT. Advanced age, advanced stage, and DLBCL subtype were also significantly associated with outcome. A new prognostic score that composed of the above 4 factors was obtained. New prognostic score stratified patients into 4 risk groups with 3-year PFS of 98.5%, 73.9%, 11.1%, and 0%, and 3-year OS of 100%, 91.3%, 55.6%, and 0% (P < 0.001 for PFS and OS). Multivariate analysis showed that the new prognostic score had the greatest ability to predict relapse (P < 0.001) and death (P < 0.001). In DLBCL patients, interim F-FDG PET/CT can provide significant independent prognostic information. Our work illustrates that the new prognostic score has the strongest potential for accurately prognostication, for stratification in clinical trials, and for design of novel strategies for DLBCL patients in the high-risk group.
我们推测，弥漫性大B细胞淋巴瘤（DLBCL）患者的客观治疗反应受多种因素影响，如病理生理、生物学和药学机制等。这项回顾性研究旨在评估临床预后因素及中期氟-18-氟脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）的预测意义，并寻找与DLBCL患者预后显著相关的新的预后预测指标。共纳入105例成年DLBCL患者进行回顾性分析。每位患者在第二个化疗周期后接受中期F-FDG PET/CT扫描。采用基于Deauville 5分法的视觉方法评估中期PET/CT扫描结果。用Kaplan-Meier曲线分析预后因素、3年无进展生存期（PFS）率和总生存期（OS）率之间的关系。用多因素分析（Cox比例风险回归模型）分析新构建的预后评分的预测价值。视觉分析显示，中期PET/CT结果为阴性的患者与中期PET/CT结果为阳性的患者在PFS和OS方面均存在统计学显著差异。高龄、晚期以及DLBCL亚型也与预后显著相关。由此获得了一个由上述4个因素组成的新的预后评分。新的预后评分将患者分为4个风险组，3年PFS分别为98.5%、73.9%、11.1%和0%，3年OS分别为100%、91.3%、55.6%和0%（PFS和OS的P均<0.001）。多因素分析表明，新的预后评分预测复发（P<0.001）和死亡（P<0.001）的能力最强。在DLBCL患者中，中期F-FDG PET/CT可提供显著的独立预后信息。我们的研究表明，新的预后评分在准确预后、临床试验分层以及为高危组DLBCL患者设计新策略方面具有最强的潜力。
