Li Cong, Yu Haifeng, Chen Xi, Han Shuiyun, Peng Shuailing, Lei Tao, Yang Haiyan
Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.
Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Front Oncol. 2022 May 23;12:772773. doi: 10.3389/fonc.2022.772773. eCollection 2022.
Roughly one third of diffuse large B cell lymphoma (DLBCL) patients experience relapsed or refractory disease, and their prognosis is unsatisfactory. It is thus important to identify patients who respond poorly to first-line treatment. Some studies have evaluated the prognostic value of interim PET-CT (iPET-CT) or end-of-treatment PET-CT (ePET-CT) in lymphoma patients, but there have been few studies exploring the prognostic value of metabolic response rates in the evaluation of DLBCL patients.
Consecutive newly diagnosed DLBCL patients were screened from March 2013 to June 2020. Patients received at least four cycles of chemotherapy, and underwent baseline, iPET-CT and ePET-CT scanning. Kaplan-Meier survival curves with log-rank tests were employed to assess survival outcomes including overall survival (OS) and progression-free survival (PFS). Independent predictors of survival were identified through univariable and multivariable Cox regression analyses.
307 patients were evaluated. At the time of iPET-CT scanning, 250, 45, and 12 patients exhibited complete response (CR), partial response (PR), and stable disease (SD)/progressive disease (PD), respectively. The percentage of negative iPET-CT was 81.4% (250/307). Among 295 patients with ePET-CT, 262 (88.8%) achieved negativity and 33 (11.2%) exhibited positivity including 26 PR and 7 PD. The 2-year PFS and 2-year OS for patients with iPET-CT positivity were 50.7% and 76.5%, respectively, and were significantly shorter than those for patients with iPET-CT negativity (2-year PFS 82.7%, <0.001; 2-year OS 94.2%, <0.001). Patients with ePET-CT positivity had significant poorer 2-year PFS (48.1%) and 2-year OS (78.5%) compared with those ePET-CT negativity (2-year PFS 83.8%, <0.001; 2-year OS 94.9%, <0.001). The positivity rates on iPET-CT and ePET-CT evaluation were significantly higher in patients in the high/high-intermediate risk group compared with patients in the low/low-intermediate group. In a multivariable analysis, high/high-intermediate international prognostic index (IPI) and ePET-CT positivity were independently associated with poor PFS and OS.
Our results suggest that the speed of metabolic response to treatment is of limited prognostic value in newly diagnosed DLBCL patients. Patients exhibiting PR at iPET-CT evaluation should carefully consider whether to change chemotherapy regimen.
大约三分之一的弥漫性大B细胞淋巴瘤（DLBCL）患者会出现复发或难治性疾病，其预后并不理想。因此，识别对一线治疗反应不佳的患者非常重要。一些研究评估了中期PET-CT（iPET-CT）或治疗结束时PET-CT（ePET-CT）在淋巴瘤患者中的预后价值，但很少有研究探讨代谢反应率在评估DLBCL患者中的预后价值。
从2013年3月至2020年6月筛选出连续的新诊断DLBCL患者。患者接受至少四个周期的化疗，并进行基线、iPET-CT和ePET-CT扫描。采用Kaplan-Meier生存曲线和对数秩检验来评估生存结局，包括总生存期（OS）和无进展生存期（PFS）。通过单变量和多变量Cox回归分析确定生存的独立预测因素。
共评估了307例患者。在iPET-CT扫描时，250例、45例和12例患者分别表现为完全缓解（CR）、部分缓解（PR）和疾病稳定（SD）/疾病进展（PD）。iPET-CT阴性的比例为81.4%（250/307）。在295例接受ePET-CT检查的患者中，262例（88.8%）为阴性，33例（11.2%）为阳性，包括26例PR和7例PD。iPET-CT阳性患者的2年PFS和2年OS分别为50.7%和76.5%，明显短于iPET-CT阴性患者（2年PFS 82.7%，<0.001；2年OS 94.2%，<0.001）。与ePET-CT阴性患者相比，ePET-CT阳性患者的2年PFS（48.1%）和2年OS（78.5%）明显更差（2年PFS 83.8%，<0.001；2年OS 94.9%，<0.001）。与低/中低风险组患者相比，高/高中风险组患者在iPET-CT和ePET-CT评估中的阳性率明显更高。在多变量分析中，高/高中国际预后指数（IPI）和ePET-CT阳性与不良的PFS和OS独立相关。
我们的结果表明，新诊断的DLBCL患者对治疗的代谢反应速度的预后价值有限。在iPET-CT评估中表现为PR的患者应仔细考虑是否改变化疗方案。
