Zhu Lili, Meng Yankai, Guo Lili, Zhao Hanqing, Shi Yue, Li Shaodong, Wang Anming, Zhang Xiaojun, Shi Jing, Zhu Jie, Xu Kai
The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.
Department of Radiology, Huaihai Hospital Affiliated with Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China.
Oncol Lett. 2021 Feb;21(2):132. doi: 10.3892/ol.2020.12393. Epub 2020 Dec 18.
The present study aimed to investigate the prognostic value of baseline F-FDG PET/CT quantitative parameters and interim treatment response, and to assess whether the combination of these could improve the predictive efficacy in patients with diffuse large B-cell lymphoma (DLBCL) receiving R-CHOP chemotherapy. PET/CT images and clinical data of 64 patients with DLBCL who had undergone F-FDG PET/CT scan before and after 3 or 4 cycles of R-CHOP chemotherapy were retrospectively reviewed. The quantitative parameters including standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum diameter of the maximum lesion (Dmax) were measured on baseline PET/CT images. Cox proportional hazards model was used to evaluate the influence of baseline PET/CT parameters, clinical indicators and interim treatment response on prognosis. Survival analysis was performed using Kaplan-Meier method. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive efficacy of the combination of baseline PET/CT parameters and interim treatment response. Ann Arbor stage, International Prognostic Index (IPI), lactate dehydrogenase (LDH), necrosis, MTVmax, TLGmax, Dmax and interim treatment response showed association with 2-year progression-free survival (PFS, P<0.05). LDH, necrosis, MTVmax, MTVsum, TLGmax, TLGsum, Dmax and interim treatment response showed association with 2-year overall survival (OS, P<0.05). Ann Arbor stage, Dmax and interim treatment response were found to be independent predictors of 2-year PFS (P<0.05), while Dmax and interim treatment response were found to be independent predictors of 2-year OS (P<0.05). The PFS and OS curves of Dmax <5.7 cm group and Dmax ≥5.7 cm group, complete response (CR) group and non-CR group were significantly different, respectively (P<0.05). The baseline F-FDG PET/CT parameters and interim treatment response have important prognostic values in DLBCL patients who received R-CHOP chemotherapy. Combined application of Dmax and interim treatment response improved the predictive efficacy of 2-year PFS. It may be helpful to identify patients who are at high-risk of relapse and to guide early clinical intervention of these patients.
本研究旨在探讨基线F-FDG PET/CT定量参数及中期治疗反应的预后价值，并评估二者联合应用能否提高接受R-CHOP化疗的弥漫性大B细胞淋巴瘤（DLBCL）患者的预测效能。回顾性分析了64例接受3或4周期R-CHOP化疗前后均行F-FDG PET/CT扫描的DLBCL患者的PET/CT图像及临床资料。在基线PET/CT图像上测量标准化摄取值（SUV）、代谢肿瘤体积（MTV）、总病灶糖酵解（TLG）及最大病灶最大径（Dmax）等定量参数。采用Cox比例风险模型评估基线PET/CT参数、临床指标及中期治疗反应对预后的影响。采用Kaplan-Meier法进行生存分析。绘制受试者工作特征（ROC）曲线分析，以评估基线PET/CT参数与中期治疗反应联合应用的预测效能。Ann Arbor分期、国际预后指数（IPI）、乳酸脱氢酶（LDH）、坏死情况、最大MTV（MTVmax）、最大TLG（TLGmax）、Dmax及中期治疗反应与2年无进展生存期（PFS，P<0.05）相关。LDH、坏死情况、MTVmax、MTV总和、TLGmax、TLG总和、Dmax及中期治疗反应与2年总生存期（OS，P<0.05）相关。发现Ann Arbor分期、Dmax及中期治疗反应是2年PFS的独立预测因素（P<0.05），而Dmax及中期治疗反应是2年OS的独立预测因素（P<0.05）。Dmax<5.7 cm组与Dmax≥5.7 cm组、完全缓解（CR）组与非CR组的PFS和OS曲线分别有显著差异（P<0.05）。基线F-FDG PET/CT参数及中期治疗反应对接受R-CHOP化疗的DLBCL患者具有重要的预后价值。联合应用Dmax及中期治疗反应可提高2年PFS的预测效能。这可能有助于识别复发高危患者并指导对这些患者进行早期临床干预。
