Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Cancer Med. 2019 Sep;8(11):5012-5022. doi: 10.1002/cam4.2404. Epub 2019 Jul 10.
The role of interim F-FDG PET/CT (iPET/CT) in diffuse large B-cell lymphoma (DLBCL) remains controversial. The purpose of this study was to assess the prognostic value of iPET/CT in patients with newly diagnosed DLBCL according to visual and semiquantitative interpretation methods.
A total of 129 newly diagnosed DLBCL patients with baseline PET/CT data were retrospectively screened. The iPET/CT findings were evaluated by the Deauville 5-point scale (DS) and ΔSUVmax. Furthermore, the reduction in SUVmax incorporated with tumor size (ΔSUVmaxΔSLD) was calculated. The optimal cutoff values of ΔSUVmax and ΔSUVmaxΔSLD were determined by receiver operating characteristic (ROC) analysis. Kaplan-Meier analysis was applied to test for the influence of prognostic values. Univariate and multivariate analyses were conducted to examine the potential independent impacts of iPET/CT.
Seventy-seven patients with PET/CT images acquired both at baseline and after four cycles of chemotherapy were finally enrolled. The optimal cutoff values for ΔSUVmax and ΔSUVmaxΔSLD were 74% and 30%, respectively. After a median follow-up of 23 months, iPET/CT findings were significant predictors of PFS and OS whenever iPET/CT was interpreted by DS, ΔSUVmax, or ΔSUVmaxΔSLD methods. ΔSUVmax-based methods were more accurate than those based on DS. The IPI, DS, ΔSUVmax, and ΔSUVmax*ΔSLD were predictive in univariate analyses. However, in the multivariate analysis, only IPI and ΔSUVmax remained independent predictors of PFS and OS.
Interim PET/CT may help to identify DLBCL patients with different prognoses. ΔSUVmax analysis shows the best accuracy and the strongest predictive value among these three methods. ΔSUVmax*ΔSLD may be a promising parameter to interpret iPET/CT images, reflecting both the changes in tumor size and metabolic activity.
18F-FDG PET/CT（iPET/CT）在弥漫性大 B 细胞淋巴瘤（DLBCL）中的作用仍存在争议。本研究旨在根据视觉和半定量解读方法评估 iPET/CT 在初诊 DLBCL 患者中的预后价值。
回顾性筛选了 129 例基线 PET/CT 数据的初诊 DLBCL 患者。采用 Deauville 5 分法（DS）和 SUVmax 差值（ΔSUVmax）评估 iPET/CT 结果。此外，计算了 SUVmax 与肿瘤大小（ΔSUVmaxΔSLD）的乘积。通过受试者工作特征（ROC）分析确定 ΔSUVmax 和 ΔSUVmaxΔSLD 的最佳截断值。Kaplan-Meier 分析用于检验预后价值的影响。进行单变量和多变量分析以检查 iPET/CT 的潜在独立影响。
最终纳入了 77 例基线和 4 个周期化疗后均获得 PET/CT 图像的患者。ΔSUVmax 和 ΔSUVmaxΔSLD 的最佳截断值分别为 74%和 30%。中位随访 23 个月后，无论使用 DS、ΔSUVmax 还是 ΔSUVmaxΔSLD 方法解读 iPET/CT 结果，均为 PFS 和 OS 的显著预测因子。基于 ΔSUVmax 的方法比基于 DS 的方法更准确。在单变量分析中，IPI、DS、ΔSUVmax 和 ΔSUVmax*ΔSLD 均具有预测价值。然而，在多变量分析中，只有 IPI 和 ΔSUVmax 仍然是 PFS 和 OS 的独立预测因子。
中期 PET/CT 有助于识别具有不同预后的 DLBCL 患者。ΔSUVmax 分析在这三种方法中具有最佳的准确性和最强的预测价值。ΔSUVmax*ΔSLD 可能是解释 iPET/CT 图像的有前途的参数，反映了肿瘤大小和代谢活性的变化。
