中期PET/CT在227例弥漫大B细胞淋巴瘤患者预后评估中的价值研究
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摘要
目的:探讨中期18F-FDG PET/CT在弥漫大B细胞淋巴瘤(DLBCL)患者疗效及预后评估中的价值。方法:在病理确诊的227例DLBCL患者治疗前及化疗后第3周期前行18F-FDC PET/CT成像。通过随访,视觉分析,Deauville评分及半定量方法,最大标准摄取值减少率(△SUVmax)分析患者的疗效及无进展生存率(PFS)、总生存率(OS),并回归分析影响生存的独立危险因素。结果:中位随访时间71月。受试者工作曲线(ROC)计算△SUVmax最佳分界点为71%,Deauville评分与△SUVmax方法评估疗效敏感度、特异度及准确度分别为86.9%、74.3%、82.8%和77.8%、63.5%、73.1%。生存曲线分析显示,Deauville评分、△SUVmax及临床国际预后指数(IPI)预测PFS、OS均具有显著意义(P=0.001)。Deauville评分与IPI是影响预后的独立危险因素。结论:中期PET/CT显像对评估DLBCL患者的疗效及预后具有显著作用。
Objective: To investigate the prognostic evaluation value of fluorodeoxyglucose(FDG) interim positron emission tomography/computed tomography(PET/CT) for diffuse large B cell lymphoma(DLBCL). Methods: Two hundred and twenty-seven patients with pathologically diagnosed DLBCL underwent 18 F-FDG scans at baseline and before 3 cycles of a rituximab-containing chemotherapy regimen. The Visual Deauville score(DS) and changes in maximum standard uptake values(△SUVmax) were calculated for tracer for the predominant lesion of each patient, for prediction of progression-free survival(PFS) and overall survival(OS) using Kaplan-Meier method and COX regression.Results: The median follow-up period was 71 months. Receiver operating characteristic analysis indicated that the best△ SUV cut-off values for FDG(△SUVFDG) was 71%. The sensitivity, specificity and accuracy of DS and △SUVmax were 86.9%, 74.3%, 82.8% and 77.8%, 63.5%, 73.1%, respectively in response assessment. Kaplan-Meier analysis showed DS, △SUVmax and IPI had significance for prediction of PFS and OS(P = 0.001). The DS 4-5 and IPI 3-5 were independent risk factors of poor prognosis by COX regression analysis. Conclusion: Interim PET/CT is important predictor for evaluation therapeutic response and prognosis in DLBCL patients.
Objective: To investigate the prognostic evaluation value of fluorodeoxyglucose(FDG) interim positron emission tomography/computed tomography(PET/CT) for diffuse large B cell lymphoma(DLBCL). Methods: Two hundred and twenty-seven patients with pathologically diagnosed DLBCL underwent 18 F-FDG scans at baseline and before 3 cycles of a rituximab-containing chemotherapy regimen. The Visual Deauville score(DS) and changes in maximum standard uptake values(△SUVmax) were calculated for tracer for the predominant lesion of each patient, for prediction of progression-free survival(PFS) and overall survival(OS) using Kaplan-Meier method and COX regression.Results: The median follow-up period was 71 months. Receiver operating characteristic analysis indicated that the best△ SUV cut-off values for FDG(△SUVFDG) was 71%. The sensitivity, specificity and accuracy of DS and △SUVmax were 86.9%, 74.3%, 82.8% and 77.8%, 63.5%, 73.1%, respectively in response assessment. Kaplan-Meier analysis showed DS, △SUVmax and IPI had significance for prediction of PFS and OS(P = 0.001). The DS 4-5 and IPI 3-5 were independent risk factors of poor prognosis by COX regression analysis. Conclusion: Interim PET/CT is important predictor for evaluation therapeutic response and prognosis in DLBCL patients.
引文
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2 Casasnovas RO,Meignan M,Berriolo-Riedinger A,et al.SUVmax reduction improves early prognosis value of interim positron emission tomography scans in diffuse large B-cell lymphoma.Blood,2011;118(1):37-43.
3 Lin C,Itti E,Haioun C,et al.Early 18F-FDG PET for prediction of prognosis in patients with diffuse large B-cell lymphoma:SUV-based assessment versus visual analysis.J Nucl Med,2007;48(10):1626-1632.
4 Cashen AF,Dehdashti F,Luo J,et al.18F-FDG PET/CT for early response assessment in diffuse large B-cell lymphoma:poor predictive value of international harmonization project interpretation.J Nucl Med,2011;52(3):386-392.
5 Meignan M,Gallamini A,Meignan M,et al.Report on the first international workshop on interim-PET scan in lymphoma.Leuk Lymphoma,2009;50(8):1257-1260.
6杨燕,朱海燕,于力.18F-FDG PET/CT对弥漫大B细胞淋巴瘤的预后评估意义研究进展.中国实验血液学杂志,2015;23(1):255-260.
7 Martelli M,Ceriani L,Zucca E,et al.18F-fluorodeoxyglucose positron emission tomography predicts survival after chemoimmunotherapy for primary mediastinal large B-cell lymphoma:results of the International Extranodal Lymphoma Study Group IELSG-26 Study.J Clin Oncol,2014;32(17):1769-1775.
8 Gallamini A,Barrington SF,Biggi A,et al.The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale.Haematologica,2014;99(6):1107-1113.
9朱璐婷,岑溪南,欧晋平等.中期18F-FDG PET/CT显像不同评价方法对弥漫大B细胞淋巴瘤患者预后判断价值.中国实验血液学杂志,2017;25(2):431-437.
10张玥伟,范洋,杨志等.化疗早期及中期18F-FDG PET/CT显像对56例弥漫大B细胞淋巴瘤患者预后的评估价值.中华血液学杂志,2015;36(10):824-829.
11 Itti E,Meignan M,Berriolo-Riedinger A,et al.An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma:comparison between Deauville criteria andΔSUVmax.Eur J Nucl Med Mol Imaging,2013;40(9):1312-1320.
12 Boellaard R.Need for standardization of 18F-FDG PET/CT for treatment response assessments.J Nucl Med,2011;52(Suppl 2):93S-100S.
13 Itti E,Lin C,Dupuis J,et al.Prognostic value of interim 18F-FDGPET in patients with diffuse large B-cell lymphoma:SUV-based assessment at 4 cycles of chemotherapy.J Nucl Med,2009;50(4):527-533.
14 Kasamon YL,Jones RJ,Wahl RL.Integrating PET and PET/CT into the risk-adapted therapy of lymphoma.J Nucl Med,2007;48(Suppl 1):19S-27S.
15 Meignan M,Gallamini A,Itti E,et al.Report on the Third InternationalWorkshop on Interim Positron Emission Tomography in Lymphoma held in Menton,France,26-27 September 2011 and Menton 2011 consensus.Leuk Lymphoma,2012;53(10):1876-1881.
16 Minamimoto R,Fayad L,Advani R,et al.Diffuse large B-cell lymphoma:prospective multicenter comparison of early lnterim FLT PET/CT versus FDG PET/CT with IHP,EORTC,Deauville,and PERCIST criteria for early therapeutic monitoring.Radiology,2016;280(1):220-229.
17 Huang HH,Xiao F,Chen FY,et al.Reassessment of the prognostic value of the International Prognostic Index and the revised International Prognostic Index in patients with diffuse large B-cell lymphoma:A multicentre study.Exp Ther Med,2012;4(3):475-480.
18 Akkas BE,Vural GU.Standardized uptake value for 18F-fluorodeoxyglucose is correlated with a high International Prognostic Index and the presence of extranodal involvement in patients with diffuse large B-cell lymphoma.Rev Esp Med Nucl Imagen Mol,2014;33(3):148-152.
19 Park S,Moon SH,Park LC,et al.The impact of baseline and interim PET/CT parameters on clinical outcome in patients with diffuse large B cell lymphoma.Am J Hematol,2012;87(9):937-940.
20 Huang H,Xiao F,Han X,et al.Correlation of pretreatment 18F-FDG uptake with clinicopathological factors and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma.Nucl Med Commun,2016;37(7):689-698.
2 Casasnovas RO,Meignan M,Berriolo-Riedinger A,et al.SUVmax reduction improves early prognosis value of interim positron emission tomography scans in diffuse large B-cell lymphoma.Blood,2011;118(1):37-43.
3 Lin C,Itti E,Haioun C,et al.Early 18F-FDG PET for prediction of prognosis in patients with diffuse large B-cell lymphoma:SUV-based assessment versus visual analysis.J Nucl Med,2007;48(10):1626-1632.
4 Cashen AF,Dehdashti F,Luo J,et al.18F-FDG PET/CT for early response assessment in diffuse large B-cell lymphoma:poor predictive value of international harmonization project interpretation.J Nucl Med,2011;52(3):386-392.
5 Meignan M,Gallamini A,Meignan M,et al.Report on the first international workshop on interim-PET scan in lymphoma.Leuk Lymphoma,2009;50(8):1257-1260.
6杨燕,朱海燕,于力.18F-FDG PET/CT对弥漫大B细胞淋巴瘤的预后评估意义研究进展.中国实验血液学杂志,2015;23(1):255-260.
7 Martelli M,Ceriani L,Zucca E,et al.18F-fluorodeoxyglucose positron emission tomography predicts survival after chemoimmunotherapy for primary mediastinal large B-cell lymphoma:results of the International Extranodal Lymphoma Study Group IELSG-26 Study.J Clin Oncol,2014;32(17):1769-1775.
8 Gallamini A,Barrington SF,Biggi A,et al.The predictive role of interim positron emission tomography for Hodgkin lymphoma treatment outcome is confirmed using the interpretation criteria of the Deauville five-point scale.Haematologica,2014;99(6):1107-1113.
9朱璐婷,岑溪南,欧晋平等.中期18F-FDG PET/CT显像不同评价方法对弥漫大B细胞淋巴瘤患者预后判断价值.中国实验血液学杂志,2017;25(2):431-437.
10张玥伟,范洋,杨志等.化疗早期及中期18F-FDG PET/CT显像对56例弥漫大B细胞淋巴瘤患者预后的评估价值.中华血液学杂志,2015;36(10):824-829.
11 Itti E,Meignan M,Berriolo-Riedinger A,et al.An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma:comparison between Deauville criteria andΔSUVmax.Eur J Nucl Med Mol Imaging,2013;40(9):1312-1320.
12 Boellaard R.Need for standardization of 18F-FDG PET/CT for treatment response assessments.J Nucl Med,2011;52(Suppl 2):93S-100S.
13 Itti E,Lin C,Dupuis J,et al.Prognostic value of interim 18F-FDGPET in patients with diffuse large B-cell lymphoma:SUV-based assessment at 4 cycles of chemotherapy.J Nucl Med,2009;50(4):527-533.
14 Kasamon YL,Jones RJ,Wahl RL.Integrating PET and PET/CT into the risk-adapted therapy of lymphoma.J Nucl Med,2007;48(Suppl 1):19S-27S.
15 Meignan M,Gallamini A,Itti E,et al.Report on the Third InternationalWorkshop on Interim Positron Emission Tomography in Lymphoma held in Menton,France,26-27 September 2011 and Menton 2011 consensus.Leuk Lymphoma,2012;53(10):1876-1881.
16 Minamimoto R,Fayad L,Advani R,et al.Diffuse large B-cell lymphoma:prospective multicenter comparison of early lnterim FLT PET/CT versus FDG PET/CT with IHP,EORTC,Deauville,and PERCIST criteria for early therapeutic monitoring.Radiology,2016;280(1):220-229.
17 Huang HH,Xiao F,Chen FY,et al.Reassessment of the prognostic value of the International Prognostic Index and the revised International Prognostic Index in patients with diffuse large B-cell lymphoma:A multicentre study.Exp Ther Med,2012;4(3):475-480.
18 Akkas BE,Vural GU.Standardized uptake value for 18F-fluorodeoxyglucose is correlated with a high International Prognostic Index and the presence of extranodal involvement in patients with diffuse large B-cell lymphoma.Rev Esp Med Nucl Imagen Mol,2014;33(3):148-152.
19 Park S,Moon SH,Park LC,et al.The impact of baseline and interim PET/CT parameters on clinical outcome in patients with diffuse large B cell lymphoma.Am J Hematol,2012;87(9):937-940.
20 Huang H,Xiao F,Han X,et al.Correlation of pretreatment 18F-FDG uptake with clinicopathological factors and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma.Nucl Med Commun,2016;37(7):689-698.