Department of Hematology, Peking University Third Hospital, Beijing, China.
Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China.
Cancer Med. 2019 Sep;8(11):5137-5147. doi: 10.1002/cam4.2284. Epub 2019 Jul 25.
In the era of rituximab, the International Prognostic Index (IPI) has been inefficient in initial risk stratification for patients with R-CHOP-treated diffuse large B-cell lymphoma (DLBCL). To estimate the predictive values of PET/CT quantitative parameters and three prognostic models consisting of baseline and interim parameters for three-year progression-free survival (PFS), we conducted an analysis of 85 patients in China with DLBCL underwent baseline and interim PET/CT scans and treated at the Department of Hematology of Peking University Third Hospital from November 2012 to November 2017. The PET/CT parameters, viz. the baseline and interim values of standardized uptake value (SUV ), total metabolic tumor volume (TMTV), and total lesion glycolysis (TLG), and their rates of change, were analyzed by a receiver operating characteristics curve, Kaplan-Meier analysis, and log-rank test. Besides, the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) was also included in the multivariate Cox hazards model. Owing to the strong correlation between TMTV and TLG at baseline and interim (Pearson's correlation coefficient, r = 0.823, P-value = 0.000, and 0.988, P-value = 0.000, respectively), only TLG was included in the multivariate Cox hazards model, where TLG > 1036.61 g and %ΔSUV < 86.02% showed predictive value independently (HR = 10.42, 95% CI 2.35-46.30, P = 0.002, and HR = 4.86, 95% CI 1.27-18.54, P = 0.021, respectively). Replacing TLG in the equation, TMTV and TMTV both showed significantly predictive abilities like TLG (HR = 8.22, 95% CI 1.86-32.24, P = 0.005, and HR = 2.96, 95% CI 1.16-7.54, P = 0.023, respectively). After dichotomy, NCCN-IPI also gave a significant performance (P = 0.035 and P = 0.010, respectively, in TLG and TMTV models). The baseline variables, that is, TMTV , TLG and dichotomized NCCN-IPI, and the interim variables TMTV and %ΔSUV , presented independent prognostic value for PFS. In prognostic model 2 (TLG + %ΔSUV ), the group with TLG > 1036.61 g and %ΔSUV < 86.02% recognized 19 (82.6%) of the relapse or progression events, which showed the best screening ability among three models consisting of baseline and interim PET/CT parameters.
在利妥昔单抗时代，国际预后指数（IPI）在接受 R-CHOP 治疗的弥漫性大 B 细胞淋巴瘤（DLBCL）患者的初始风险分层中效率低下。为了评估 PET/CT 定量参数和三个包含基线和中期参数的预后模型对于 3 年无进展生存（PFS）的预测价值，我们对 2012 年 11 月至 2017 年 11 月在中国北京大学第三医院血液科接受基线和中期 PET/CT 扫描并接受治疗的 85 例 DLBCL 患者进行了分析。通过受试者工作特征曲线、Kaplan-Meier 分析和对数秩检验分析了 PET/CT 参数，即基线和中期标准化摄取值（SUV）、总代谢肿瘤体积（TMTV）和总病变糖酵解（TLG）及其变化率。此外，还将国家综合癌症网络国际预后指数（NCCN-IPI）纳入多变量 Cox 风险模型。由于 TMTV 和 TLG 在基线和中期具有很强的相关性（Pearson 相关系数，r=0.823，P 值=0.000 和 0.988，P 值=0.000），仅 TLG 被纳入多变量 Cox 风险模型，其中 TLG>1036.61 g 和 %ΔSUV<86.02% 具有独立的预测价值（HR=10.42，95%CI 2.35-46.30，P=0.002 和 HR=4.86，95%CI 1.27-18.54，P=0.021）。在方程中替换 TLG 后，TMTV 和 TMTV 都显示出与 TLG 相似的显著预测能力（HR=8.22，95%CI 1.86-32.24，P=0.005 和 HR=2.96，95%CI 1.16-7.54，P=0.023）。经过二分法后，NCCN-IPI 也表现出显著的性能（在 TLG 和 TMTV 模型中，P=0.035 和 P=0.010）。基线变量，即 TMTV、TLG 和二分类的 NCCN-IPI，以及中期变量 TMTV 和 %ΔSUV，为 PFS 提供了独立的预后价值。在预后模型 2（TLG+%ΔSUV）中，TLG>1036.61 g 和 %ΔSUV<86.02%的组识别出 19 次（82.6%）复发或进展事件，在包含基线和中期 PET/CT 参数的三个模型中具有最佳的筛查能力。
