通过一种新的中期正电子发射断层扫描-计算机断层扫描评估模型改善弥漫性大 B 细胞淋巴瘤患者的化疗耐药预测。
Improved prediction of chemoresistance in patients with diffuse large B-cell lymphoma through a new interim positron emission tomography-computed tomography evaluation model.
机构信息
Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Nuclear Medicine, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Acta Oncol. 2021 Jun;60(6):735-743. doi: 10.1080/0284186X.2021.1894477. Epub 2021 Mar 15.
OBJECTIVES
The positron emission tomography (PET) could predict the prognosis of DLBCL patients, but the exact procedure on interim PET (iPET) to determine chemoresistant patients remains elusive.
METHODS
We retrospectively analyzed 593 newly diagnosed DLBCL patients uniformly treated with R-CHOP regimen. Among them, 352 patients diagnosed from August 2010 to December 2016 were included in the test cohort and 241 patients diagnosed from January 2017 to December 2019 were included in the validation cohort. The iPET was evaluated with Deauville criteria and ΔSUVmax method. The reduction of maximal SUV between baseline and after 4 cycles of chemotherapy were defined as ΔSUVmax. The survival functions were depicted using the Kaplan-Meier method and compared with the log-rank test.
RESULTS
Patients with iPET Deauville 4 had heterogeneous outcome and end of treatment complete response rates (eCRR). Combined Deauville with ΔSUVmax method, we proposed a modified-Deauville model: patients with Deauville 4 and ΔSUVmax > 70%, as well as those with Deauville 1-3, were reclassified into the modified-Deauville negative group, while patients with Deauville 4 and ΔSUVmax ≤ 70%, as well as those with Deauville 5, into the modified-Deauville positive group. In the test cohort, 3-year PFS, OS and eCRR of modified-Deauville negative group were 80.2%, 89.9% and 91.8%, significantly higher than those of positive group (12.5%, 27.3% and 29.2%, ≤ .001). Similar results were found in the validation cohort, that 3-year PFS, OS and eCRR were 87.8%, 95.4%, 96.3% in modified-Deauville negative group, and 27.4%, 32.5%, 13.5% in positive group. Through modified-Deauville model, patients in iPET positive group had very low eCRR and were resistant to conventional chemotherapy.
CONCLUSIONS
The modified-Deauville model could better distinguish DLBCL patients with poor response to chemotherapy. Accordingly, these patients could be recognized early and provided with alternative therapeutic agents, which might improve the clinical outcome of refractory DLBCL patients.
目的
正电子发射断层扫描（PET）可预测弥漫性大 B 细胞淋巴瘤（DLBCL）患者的预后，但确定化疗耐药患者的中期 PET（iPET）的确切方法仍不明确。
方法
我们回顾性分析了 593 例新诊断的 DLBCL 患者，这些患者均接受 R-CHOP 方案治疗。其中，352 例患者于 2010 年 8 月至 2016 年 12 月期间确诊，纳入试验队列；241 例患者于 2017 年 1 月至 2019 年 12 月期间确诊，纳入验证队列。采用 Deauville 标准和ΔSUVmax 方法评估 iPET。化疗 4 周期后 SUVmax 的最大减少值定义为ΔSUVmax。采用 Kaplan-Meier 法描绘生存函数，并采用对数秩检验进行比较。
结果
iPET Deauville 评分 4 分的患者预后不同，治疗结束时完全缓解率（eCRR）也不同。结合 Deauville 评分和ΔSUVmax 方法，我们提出了一种改良的 Deauville 模型：Deauville 评分 4 分且ΔSUVmax＞70%，以及 Deauville 评分 1-3 分的患者被重新分类为改良的 Deauville 阴性组；而 Deauville 评分 4 分且ΔSUVmax≤70%，以及 Deauville 评分 5 分的患者被重新分类为改良的 Deauville 阳性组。在试验队列中，改良的 Deauville 阴性组的 3 年无进展生存率（PFS）、总生存率（OS）和 eCRR 分别为 80.2%、89.9%和 91.8%，显著高于阳性组的 12.5%、27.3%和 29.2%（ ≤ 0.001）。在验证队列中也观察到了类似的结果，即改良的 Deauville 阴性组的 3 年 PFS、OS 和 eCRR 分别为 87.8%、95.4%和 96.3%，阳性组的 3 年 PFS、OS 和 eCRR 分别为 27.4%、32.5%和 13.5%。通过改良的 Deauville 模型，iPET 阳性组的患者 eCRR 非常低，对常规化疗有耐药性。
结论
改良的 Deauville 模型可更好地区分对化疗反应不佳的 DLBCL 患者。因此，可早期识别这些患者并为其提供替代治疗药物，这可能会改善难治性 DLBCL 患者的临床结局。
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