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18F-FDG PET/CT代谢参数及临床指标在弥漫性大B细胞淋巴瘤中期评估及预后预测中的意义

Significance of metabolic parameters and biochemical indexes of 18F-FDG PET/CT in the mid-term evaluation and prognosis of diffuse large B-cell lymphoma

    摘要
  • 摘要: 目的 探讨18F-氟代脱氧葡萄糖（18F-FDG）PET/CT的代谢参数及临床指标在弥漫性大B细胞淋巴瘤（DLBCL）中期评估及预后预测中的意义。 方法 收集194例DLBCL患者临床资料,记录患者的中期评估结果,比较不同临床指标β2 -微球蛋白（β2-MG）、双表达、三表达、Ann Arbor分期、淋巴瘤国际预后评分 （IPI）、多维尔5分法（D5PS）评分和18F-FDG PET/CT代谢参数最大标准化摄取值（SUVmax）、病灶累及部位SUVmax的总和（SUVmaxsum）、平均标准化摄取值（SUVmean）和SUVmax下降幅度（△SUVmax）中达完全缓解（CR）者所占比例的差异,应用Cox回归和Kaplan-Meier生存分析法分析18F-FDG PET/CT代谢参数及临床指标对DCBCL患者2年无进展生存期（PFS）的影响,并对SUVmax与β2-MG、Ann Arbor分期和IPI评分进行相关性分析。 结果 β2-MG > 2.3 mg/L、Ann Arbor分期Ⅲ/Ⅳ期、IPI > 2分、SUVmax > 17.00和SUVmaxsum > 38.60者达CR的比例较低;疗效达CR者△SUVmax大于未达CR者（P均 < 0.05）。Cox单因素分析显示,β2-MG、Ann Arbor分期、IPI评分、双表达、三表达、SUVmaxsum及D5PS评分均与DLBCL患者2年PFS有关（P均 < 0.05）;多因素分析显示,Ann Arbor分期Ⅲ/Ⅳ期（HR = 4.486,P = 0.001）为DLBCL患者2年PFS的独立危险因素,D5PS 评分1~3分（HR = 0.256,P < 0.001）为DLBCL患者2年PFS的独立保护因素。Spearman秩相关分析显示,SUVmax与β2-MG（rs = 0.348,P = 0.001）、Ann Arbor分期（rs = 0.236,P = 0.022）和IPI评分（rs = 0.305,P = 0.003）均有关。 结论 18F-FDG PET/CT的代谢参数与临床指标相关,Ann Arbor分期和D5PS可作为DLBCL患者预后的参考指标。

     

    Abstract: Objective To investigate the significance of metabolic parameters and biochemical indexes of 18F-FDG-PET/CT in the mid-term evaluation and prognosis of diffuse large B-cell lymphoma （DLBCL）. Methods Clinical data of 194 patients with DLBCL were analyzed retrospectively. The mid-term evaluation results were recorded. The proportion of patients who achieved complete remission （CR） was statistically compared among different clinical indexes（β2-microglobulin （β2-MG）, dual expression, triple expression, Ann Arbor stage, international prognostic index （IPI） and Deauville 5-point scale （D5PS） score） and metabolic parameters of 18F-FDG-PET/CT （the maximum standardized uptake value （SUVmax）, the sum of the maximum standardized uptake value （SUVmaxsum）, the mean standardized uptake value （SUVmean） and the maximum decrease range of SUV （△SUVmax））. The influence of metabolic parameters and biochemical indexes of18F-FDG-PET/CT on the 2-year progression-free survival （PFS） was evaluated by Cox regression models and Kaplan-Meier survival analysis. The correlation between SUVmax and β2-MG, Ann Arbor stage and IPI score was analyzed. Results The proportion of patients with β2-MG > 2.3 mg/L, Ann Arbor stage Ⅲ/Ⅳ, IPI score > 2, SUVmax > 17.00 and SUVmaxsum > 38.60 who achieved CR was significantly decreased, the △SUVmax of patients achieving CR was significantly higher than that of those without CR（all P < 0.05）. Univariate Cox regression analysis showed that β2-MG, Ann Arbor stage, IPI score, dual expression, triple expression, SUVmaxsum and D5PS socre were significantly correlated with the 2-year PFS of DLBCL patients （all P < 0.05）. Multivariate analysis showed that Ann Arbor stage Ⅲ/Ⅳ （HR = 4.486, P = 0.001） was an independent risk factor for the 2-year PFS, and D5PS score of 1-3 （HR = 0.256, P < 0.001） was an independent protective factor for the 2-year PFS of patients with DLBCL. Spearman’s rank correlation analysis demonstrated that SUVmax was significantly associated with β2-MG （rs = 0.348, P = 0.001）, Ann Arbor stage （rs = 0.236, P = 0.022） and IPI score （rs = 0.305, P = 0.003）. Conclusions The metabolic parameters of18F-FDG-PET/CT are associated with clinical indexes. Ann Arbor stage and D5PS can be utilized as reference indexes for clinical prognosis of DLBCL patients.

     

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