弥漫性大 B 细胞淋巴瘤 CT 临时应答：预测结局的最佳肿瘤最大径缩小率（ΔSPD）是多少？
Interim response in diffuse large B cell lymphoma on CT: what is the optimal size reduction (ΔSPD) for predicting outcome?
机构信息
Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
出版信息
Eur Radiol. 2020 Jun;30(6):3094-3100. doi: 10.1007/s00330-019-06552-7. Epub 2020 Feb 17.
OBJECTIVES
To investigate whether there was an optimal interim size reduction (iΔSPD) cutoff value that could discriminate diffuse large B cell lymphoma (DLBCL) patients with poor prognosis.
METHODS
This retrospective study enrolled 265 newly diagnosed DLBCL patients with baseline and interim (after 3 cycles) contrast-enhanced computed tomographic scan (CECT) available. Two radiologists evaluated CECT images and selected target lesions according to the Lugano Response Criteria. Lymph nodes greater than 15 mm in longest diameter (LDi) and extra-nodal lesions with LDi greater than 10 mm could be chosen as target lesions and used to calculate iΔSPD. A software tool, X-Tile, was used to calculate the optimal iΔSPD cutoff value to differentiate patients with good vs. poor prognosis. Receiver operating characteristic curve analysis, Cox regression analysis, and Kaplan-Meier analyses were further used to validate the optimal cutoff value.
RESULTS
The optimal cutoff value of iΔSPD calculated by X-tile was 80%. Compared with 50% and 100%, 80% cutoff value had the intermediate sensitivity and specificity (57.75% and 86.69% for overall survival (OS), 48.98% and 92.22% for progression-free survival (PFS), respectively), but the maximal Youden index (0.4744 for OS, 0.4120 for PFS, respectively) and areas under the curve (0.737 [0.680, 0.789] for OS). Cox regression analysis also revealed that iΔSPD < 80% could independently predict an inferior OS and PFS (both p < 0.001) while neither iΔSPD < 50% nor iΔSPD = 100% could.
CONCLUSIONS
iΔSPD with the cutoff value 80% is an independent predictor of PFS and OS for patients with DLBCL. Results suggest that treatment should be modified for patients with iΔSPD < 80%.
KEY POINTS
• The aim of interim response assessment is to identify patients whose disease has not responded to or has progressed on induction therapy. • A cutoff value of 80% in size reduction (ΔSPD) is an independent predictor of PFS and OS for DLBCL patients and is better than 50%. • In DLBCL patients with interim ΔSPD < 80%, a change to a more efficient therapy should be considered.
目的
探究是否存在最佳的中期缩小幅度（iΔSPD）截断值，以区分预后不良的弥漫性大 B 细胞淋巴瘤（DLBCL）患者。
方法
本回顾性研究纳入了 265 例基线和中期（3 个周期后）有对比增强 CT 扫描（CECT）可用的新诊断为 DLBCL 的患者。两名放射科医生根据 Lugano 缓解标准评估 CECT 图像并选择目标病灶。最长直径（LDi）大于 15mm 的淋巴结和 LDi 大于 10mm 的结外病灶可被选为目标病灶，并用于计算 iΔSPD。使用 X-Tile 软件工具计算最佳 iΔSPD 截断值，以区分预后良好和预后不良的患者。进一步使用受试者工作特征曲线分析、Cox 回归分析和 Kaplan-Meier 分析验证最佳截断值。
结果
X-tile 计算的 iΔSPD 的最佳截断值为 80%。与 50%和 100%相比，80%的截断值具有中等的敏感性和特异性（总生存率（OS）为 57.75%和 86.69%，无进展生存率（PFS）为 48.98%和 92.22%），但最大的 Youden 指数（OS 为 0.4744，PFS 为 0.4120）和曲线下面积（OS 为 0.737[0.680，0.789]）。Cox 回归分析还表明，iΔSPD<80%可独立预测较差的 OS 和 PFS（均 p<0.001），而 iΔSPD<50%或 iΔSPD=100%均不能。
结论
截断值为 80%的 iΔSPD 是 DLBCL 患者 PFS 和 OS 的独立预测因子。结果表明，对于 iΔSPD<80%的患者，应改变治疗方法。
关键要点
中期反应评估的目的是确定疾病对诱导治疗无反应或进展的患者。
缩小幅度（ΔSPD）的 80%是 DLBCL 患者 PFS 和 OS 的独立预测因子，优于 50%。
在 iΔSPD<80%的 DLBCL 患者中，应考虑改用更有效的治疗方法。
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