Li Ying-He, Zhao Yu-Mo, Jiang Yong-Luo, Tang Si, Chen Mei-Ting, Xiao Zi-Zheng, Fan Wei, Hu Ying-Ying, Zhang Xu
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
Eur J Nucl Med Mol Imaging. 2022 Mar;49(4):1311-1321. doi: 10.1007/s00259-021-05581-z. Epub 2021 Oct 15.
The aim of this study was to determine a better criterion for end-of-treatment PET (EoT-PET) assessment and prognostic evaluation of patients with diffuse large B cell lymphoma (DLBCL).
EoT-PET scans were assessed using the visual Deauville 5-point scale (5PS) and LLR, the maximum standard uptake value ratio between the lesion and the liver. The cutoff value of LLR was obtained by receiver operator characteristic curve analysis. Patient outcomes were compared using Kaplan-Meier survival analysis. Prognostic indexes of different criteria were compared. Multivariate Cox regression analysis was performed to evaluate the prognostic factors.
Four hundred forty-nine newly diagnosed DLBCL patients who received rituximab-based immunochemotherapy were included, and the median follow-up duration was 41.4 months. Patients with Deauville score (DS) 4 displayed significantly longer PFS and OS compared with patients with DS 5 (both p < 0.001), and they had significantly shorter PFS (p < 0.01) but similar OS (p = 0.057) compared with patients with DS 1-3. The differences in PFS and OS between groups were all significant whether positive EoT-PET was defined as DS 4-5 or DS 5 (all p < 0.001). The optimal cutoff of LLR was 1.83, and both PFS and OS were significantly different between EoT-PET-positive and EoT-PET-negative patients as defined by the cutoff (both p < 0.001). LLR-based criterion displayed higher specificity, positive predictive value, and accuracy than 5PS-based criterion in the prediction of disease progression and death events. In the multivariate analysis, positive EoT-PET (as defined by LLR) was related to unfavorable PFS and OS (both p < 0.001). Additional treatment was not correlated with outcomes of EoT-PET-negative patients either defined by LLR or 5PS or EoT-PET-positive patients classified by 5PS, but it was the only beneficial factor for OS (p < 0.05) in EoT-PET-positive patients with LLR ≥ 1.83.
The optimal cutoff of LLR may be superior to Deauville criteria in identifying low-risk DLBCL patients with negative EoT-PET after the first-line immunochemotherapy and sparing them the cost and toxicity of additional treatment.
本研究旨在确定弥漫性大B细胞淋巴瘤（DLBCL）患者治疗结束时PET（EoT-PET）评估及预后评估的更好标准。
采用视觉Deauville 5分制（5PS）和病变与肝脏最大标准摄取值比值（LLR）评估EoT-PET扫描结果。通过受试者工作特征曲线分析获得LLR的截断值。采用Kaplan-Meier生存分析比较患者预后。比较不同标准的预后指标。进行多因素Cox回归分析以评估预后因素。
纳入449例接受基于利妥昔单抗免疫化疗的新诊断DLBCL患者，中位随访时间为41.4个月。Deauville评分（DS）为4分的患者与DS为5分的患者相比，无进展生存期（PFS）和总生存期（OS）显著更长（均p<0.001），与DS为1-3分的患者相比，其PFS显著更短（p<0.01），但OS相似（p=0.057）。无论将EoT-PET阳性定义为DS 4-5还是DS 5，各组间PFS和OS的差异均具有统计学意义（均p<0.001）。LLR的最佳截断值为1.83，根据该截断值定义的EoT-PET阳性和阴性患者的PFS和OS均有显著差异（均p<0.001）。在预测疾病进展和死亡事件方面，基于LLR的标准比基于5PS的标准具有更高的特异性、阳性预测值和准确性。多因素分析中，EoT-PET阳性（根据LLR定义）与不良的PFS和OS相关（均p<0.001）。额外治疗与根据LLR或5PS定义的EoT-PET阴性患者或根据5PS分类的EoT-PET阳性患者的预后均无相关性，但对于LLR≥1.83的EoT-PET阳性患者，额外治疗是OS的唯一有益因素（p<0.05）。
在识别一线免疫化疗后EoT-PET阴性的低风险DLBCL患者并避免其接受额外治疗的费用和毒性方面，LLR的最佳截断值可能优于Deauville标准。
