Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
Korean J Intern Med. 2019 Jul;34(4):894-901. doi: 10.3904/kjim.2017.174. Epub 2018 Feb 23.
BACKGROUND/AIMS: The role of [18F]-f luorodeoxyglucose positron emission tomography-computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) in first remission is unclear.
Medical costs within the first 3 years of treatment completion and clinical outcomes of 118 patients with DLBCL in first remission with and without surveillance PET/CT (PET/CT [+] group [n = 76] and PET/CT [-] group [n = 42], respectively) were retrospectively analyzed.
In a propensity matched cohort with adjustment for International Prognostic Index risk and relapse, the PET/CT (+) group was shown to have similar medical costs as the PET/CT (-) group. Relapse-free survival (RFS) and overall survival (OS) were comparable between the two groups (median RFS not reached [NR] for both groups, p = 0.133; median OS NR, p = 0.542). Among 76 patients with surveillance PET/CT, 31 (40.8%) had findings suggestive of recurrence and 16 of these (51.6%) were later confirmed to have recurrent disease. Fifteen patients (48.4%) were confirmed to not have recurrence after follow-up CT or PET/CT evaluation (n = 10) and biopsy (n = 4). None of the patients with negative PET/CT findings had disease recurrence. Sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT for detection of recurrence were 1, 0.75, 0.52, and 1, respectively.
Surveillance PET/CT resulted in similar clinical outcomes and medical costs compared to no surveillance PET/CT. Approximately half of patients with PET/CT findings of recurrence had no recurrence after follow-up imaging and biopsy, which would not have been carried out if PET/CT had not been performed in the first place.
背景/目的：在缓解期的弥漫性大 B 细胞淋巴瘤（DLBCL）患者中，[18F]-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（PET/CT）的作用尚不清楚。
回顾性分析了 118 例缓解期 DLBCL 患者（分别为 PET/CT [+]组[n=76]和 PET/CT [-]组[n=42]）的治疗完成后 3 年内的医疗费用和临床结局。
在经过国际预后指数风险和复发调整的倾向匹配队列中，PET/CT（+）组的医疗费用与 PET/CT（-）组相似。两组患者的无复发生存率（RFS）和总生存率（OS）相似（两组的中位 RFS 均未达到[NR]，p=0.133；中位 OS NR，p=0.542）。在 76 例行监测 PET/CT 的患者中，31 例（40.8%）有复发的迹象，其中 16 例（51.6%）后来被证实有复发疾病。15 例（48.4%）在随访 CT 或 PET/CT 评估（n=10）和活检（n=4）后被证实无复发。所有 PET/CT 结果阴性的患者均未出现疾病复发。PET/CT 对复发的检测的敏感性、特异性、阳性预测值和阴性预测值分别为 1、0.75、0.52 和 1。
与不进行监测 PET/CT 相比，监测 PET/CT 可获得相似的临床结局和医疗费用。大约一半的 PET/CT 检查结果提示有复发的患者在随访影像学和活检后无复发，如果最初不进行 PET/CT 检查，这些患者可能不会进行这些检查。
