Prognostic value of three valuation methods of interim 18F-FDG PET/CT in diffuse large B-cell lymphoma
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摘要:
目的 探讨中期18F-FDG PET/CT的Deauville 5分法（Deauville 5-PS）、病灶与肝脏最大标准摄取值（SUVmax）的比值（LLR）、化疗前与化疗中期SUVmax的变化率（ΔSUVmax）3种评价方法在弥漫性大B细胞淋巴瘤（DLBCL）预后预测中的价值。 方法 回顾性分析117例初治的DLBCL患者资料，采用Deauville 5-PS、LLR、ΔSUVmax对化疗中期PET/CT进行分析。采用ROC曲线计算LLR、ΔSUVmax预测患者无进展生存（PFS）和总生存（OS）的最佳临界值。采用Kaplan-Meier生存分析、单因素和多因素Cox比例风险回归模型对2年PFS率及OS率进行预后分析。 结果 117例DLBCL患者中，疾病进展46例（39.3%），死亡34例（29.1%）。Deauville 5-PS、LLR、ΔSUVmax分别以4分、1.81、75%为界值时，ΔSUVmax预测DLBCL患者PFS和OS的特异性、阳性预测值、准确度均高于LLR，LLR均高于Deauville 5-PS，但Deauville 5-PS预测DLBCL患者PFS、OS的敏感度最高。Deauville 5-PS < 4分组与≥4分组患者2年PFS率和OS率分别为80.8%和93.4%、49.3%和65.6%，差异有统计学意义（P < 0.001）；LLR < 1.81组与≥1.81组患者2年PFS率和OS率分别为82.4%和89.4%、27.2%和56.3%，差异有统计学意义（P < 0.001）。ΔSUVmax>75%与ΔSUVmax≤75%组患者2年PFS率和OS率分别为86.2%和93.1%、20.5%和48.9%，差异有统计学意义（P < 0.001）。单因素分析显示Deauville 5-PS、LLR、ΔSUVmax均是DLBCL患者PFS和OS的预后影响因素（P < 0.01）。多因素分析显示，ΔSUVmax和国际预后指数评分是DLBCL患者PFS、OS的独立危险因素。 结论 中期PET/CT的Deauville 5-PS、LLR、ΔSUVmax3种评价方法均能预测DLBCL患者的预后，其中ΔSUVmax预测效能优于Deauville 5-PS和LLR，而且△SUVmax对DLBCL的预后具有独立预测价值。 -
关键词:
- 弥漫性大B细胞淋巴瘤 /
- 正电子发射断层显像术 /
- 体层摄影术 /
- X线计算机 /
- 氟代脱氧葡萄糖 /
- 预后
Abstract:Objective To investigate the efficacy of Deauville visual 5-point scale (Deauville 5-PS), the ratio of the maximum standard uptake (SUVmax) of a lesion to the liver (LLR), and the change rate of SUVmax (ΔSUVmax) before and during chemotherapy for interim 18F-FDG PET/CT in the prognosis prediction of large B- cell lymphoma (DLBCL). Methods We conducted a retrospective analysis of medical data from 117 treatment-naive DLBCL patients, and applied Deauville 5-PS, LLR and ΔSUVmax to analyze the status of mid-term chemotherapy PET/CT. ROC curve was used to calculate the optimal critical values of LLR and ΔSUVmax for predicting the progression-free survival (PFS) and overall survival (OS). Kaplan-Meier survival analysis and univariate and multivariate Cox proportional hazards regression model were applied to analyze the prognosis of 2-year PFS rate and OS rate. Results Among the 117 patients with DLBCL, 46 (39.3%) progressed and 34 (29.1%) died. At Deauville 5-PS, LLR and ΔSUVmax set to 4, 1.81, and 75%, respectively, the specificity, positive predictive value and accuracy of ΔSUVmax in predicting the PFS and OS of DLBCL patients were found to be higher than those with LLR alone, which was higher than that for Deauville 5-PS alone. However, Deauville 5-PS alone had the highest sensitivity for predicting PFS and OS in DLBCL patients. The 2-year PFS and OS rates of patients in the Deauville 5-PS < 4 group and ≥4 group were 80.8%, 93.4% and 49.3%, 65.6%, respectively (P < 0.001). The 2-year PFS and OS rates of patients with LLR < 1.81 and ≥1.81 were 82.4%, 89.4% and 27.2%, 56.3%, respectively (P < 0.001). The 2-year PFS and OS rates of patients with ΔSUVmax>75% and ΔSUVmax≤75% were 86.2%, 93.1% and 20.5%, 48.9%, respectively(P < 0.001). Univariate analysis revealed that Deauville 5-PS, LLR, and ΔSUVmax were all prognostic factors of PFS and OS in DLBCL patients (P < 0.01). Multivariate analysis showed that ΔSUVmax and international prognostic index scores served as independent risk factors for PFS and OS in DLBCL patients. Conclusion All three evaluation methods of Deauville 5-PS, LLR and ΔSUVmax of interim PET/CT can predict the prognosis of DLBCL patients, among which ΔSUVmax show better predictive efficacy than Deauville 5-PS and LLR and ΔSUVmax had an independent predictive value for the prognosis of DLBCL. -
图 1 一位21岁女性DLBCL患者PET/CT图像
Figure 1. PET/CT images of a 21-year-old female patient presenting with DLBCL. Follow-up record of 57 months showed neither tumor progression or death. Deauville 5-PS and LLR predictions were false-positive, while ΔSUVmax predictions were accurate. A: PET/CT MIP image before chemotherapy showed multiple swollen lymph nodes in the bilateral supraclavicular and mediastinum, some of which were fused into clump-like changes, with significantly increased FDG uptake; B: PET/CT fusion imagebefore chemotherapy showed the maximum cross-section of the mediastinal mass of approximately 10.8 cm×8.8 cm×12.0 cm, with an SUVmax of 18.79; C: The interim PET/CT fusion image showed a significant reduction in mediastinal lesions and a significant decrease in the FDG uptake, with an SUVmax of 4.03 and ΔSUVmax of 79% (< 75.0%), but Deauville 5-PS of 4 and LLR of 2.37 (≥1.81); D: The interim PET/CT MIP images showed multiple lesions shrinking in the bilateral supraclavicular and mediastinum, with a significant decrease in the FDG uptake. Physiological uptake of the intestinal tube can be seen in the right middle and lower abdomen regions.
表 1 中期PET/CT3种评价方法对117例DLBCL患者PFS、OS的预测效能
Table 1. Predictive efficacy of interim PET/CT three evaluation methods for PFS and OS in 117 patients with DLBCL
Variable Critical value Sensitivity (%) Specificity (%) Positive predictive value(%) Negative predictive value(%) Accuracy (%) PFS Deauville 5-PS 4 76.1 53.5 51.5 77.6 62.4 LLR 1.81 69.6 78.9 68.1 80.0 75.2 ΔSUVmax 75.0% 69.6 85.9 76.2 81.3 79.5 OS Deauville 5-PS 4 85.3 53.0 42.6 89.8 62.4 LLR 1.81 67.6 71.1 48.9 84.3 70.1 ΔSUVmax 75.0% 73.5 79.5 59.5 88.0 77.8 PFS: Progression-free survival; OS: Overall survival; Deauville 5-PS: Deauville 5-point scale; LLR: Lesion-to-liver SUVmax ratio; SUVmax: Maximum standard uptake value. 
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表 2 影响DLBCL患者PFS和OS的单因素分析
Table 2. Univariate analysis of prognostic factors for PFSand OS(%)
Characteristics 2-year PFS χ2 P 2-year OS χ2 P Gender 2.254 0.133 2.946 0.086 Male (n=70) 57.4 72.6 Female (n=47) 69.4 84.3 Age (year) 0.951 0.329 7.798 0.094 < 60(n=45) 65.1 84.0 ≥60(n=72) 60.2 73.1 Ann Arbor Stage 4.157 0.041 2.118 0.146 Ⅰ-Ⅱ(n=30) 71.7 79.9 Ⅲ-Ⅳ (n=87) 60.1 76.4 IPI 2.471 0.116 4.964 0.026 Low risk (n=49) 71.2 85.5 High risk (n=68) 56.4 71.2 Deauville 5-PS 12.389 < 0.001 14.732 < 0.001 < 4 (n=49) 80.8 93.4 ≥4 (n=68) 49.3 65.6 LLR 35.986 < 0.001 18.490 < 0.001 < 1.81 (n=74) 82.4 89.4 ≥1.81 (n=43) 27.2 56.3 ΔSUVmax 55.869 < 0.001 35.898 < 0.001 ≥75.0% (n=42) 86.2 93.1 < 75.0% (n=75) 20.5 48.9 IPI: International prognostic index.
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表 3 影响DLBCL患者PFS和OS的Cox多因素分析
Table 3. Analysis results of Cox multivariable regression in PFS and OS
Index PFS OS HR 95% CI P HR 95% CI P Deauville 5-PS 2.702 0.701-10.415 0.149 0.566 0.161-1.984 0.373 LLR 0.301 0.087-1.042 0.058 1.133 0.406-3.158 0.812 ΔSUVmax 6.585 2.461-17.621 < 0.001 0.001 2.045-17.483 0.001 Ann Arbor stage 0.748 0.320-1.750 0.503 IPI 0.456 0.211-0.986 0.046
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