Department of Oncology and Medical Research Center, Oulu University Hospital, Oulu, Finland.
Unit of Cancer and Translational Medicine Research, Oulu University, Oulu, Finland.
Cancer Med. 2021 May;10(9):3035-3044. doi: 10.1002/cam4.3867. Epub 2021 Mar 31.
The application of positron emission tomography (PET)-computed tomography (CT) in treatment response evaluation has increased in diffuse large B-cell lymphoma (DLBCL), although its predictive value is controversial. We retrospectively analyzed the rate of false-positive PET-CTs performed as interim (n = 94) and end-of-treatment (n = 8) assessments among 102 DLBCL patients treated during 2010-2017 at Oulu University Hospital. In PET-CT Deauville score ≥4 was regarded as positive. A biopsy was performed on 35 patients, and vital lymphoma tissue was detected from nine patients. Positive biopsy findings were associated with poor disease outcomes in this study. This difference was statistically significant: 2-year failure-free survival (FFS) was 44% in patients with a positive biopsy versus 83% for those with a negative biopsy (p = 0.003). The corresponding overall survival (OS) rates were 53% versus 95% (p = 0.010). In the multivariate analyses, a negative biopsy was an independent protective factor in FFS (Hazard Ratio (HR) 0.093 (95% confidence interval [CI] 0.017-0.511); p = 0.006) unrelated to the International Prognostic Index (IPI) (HR 1.139 [95% CI 0.237-5.474] p = 0.871) or stage (HR 1.365 [95% CI 0.138-13.470]; p = 0.790). There was no statistically significant difference in OS according to the PET results, but the FFS rate was significantly higher in patients with a negative PET. The value of PET-CT as an evaluation method suffers from a high false-positive rate, and it is inadequate alone for the justification of treatment decisions. Biopsy results provide more reliable prognostic information for the evaluation of treatment response and outcome and should be used to assess patients with positive PET-CT scans.
正电子发射断层扫描（PET）-计算机断层扫描（CT）在弥漫性大 B 细胞淋巴瘤（DLBCL）的治疗反应评估中的应用有所增加，尽管其预测价值存在争议。我们回顾性分析了 2010 年至 2017 年期间在奥卢大学医院治疗的 102 例 DLBCL 患者中 94 例作为中期和 8 例作为治疗结束时进行的假阳性 PET-CT 率。在 PET-CT Deauville 评分≥4 被认为是阳性。对 35 例患者进行了活检，从 9 例患者中检测到有活力的淋巴瘤组织。本研究中，阳性活检结果与不良疾病结局相关。这一差异具有统计学意义：有阳性活检的患者 2 年无失败生存率（FFS）为 44%，而阴性活检的患者为 83%（p=0.003）。相应的总生存率（OS）分别为 53%和 95%（p=0.010）。在多变量分析中，阴性活检是 FFS 的独立保护因素（风险比（HR）0.093（95%置信区间 [CI] 0.017-0.511）；p=0.006）与国际预后指数（IPI）无关（HR 1.139（95%CI 0.237-5.474）p=0.871）或分期（HR 1.365（95%CI 0.138-13.470）；p=0.790）。根据 PET 结果，OS 无统计学差异，但阴性 PET 的 FFS 率显著更高。PET-CT 作为评估方法的价值存在较高的假阳性率，单独使用不足以证明治疗决策的合理性。活检结果为评估治疗反应和结局提供了更可靠的预后信息，应用于评估阳性 PET-CT 扫描的患者。
