18 F-FDG PET/CT代谢参数判断II~III期弥漫大B细胞淋巴瘤的预后价值

Abstract

Objective To investigate the prognostic value of the maximum standardized uptake value(SUVmax), metabolic tumor volume(MTV) and total lesion glycolysis(TLG) calculated from pretreatment 18F-FDG PET/CT results in patients with diffuse large B-cell lymphoma of stage Ⅱ~Ⅲ disease. Methods A total of 85 patients with DLBCL of stage Ⅱ~Ⅲ disease were enrolled from June 2009 to December 2015, and the clinic data and pretreatment 18F-FDG PET/CT data were retrospectively analyzed. MTV and TLG of tumor tissue were calculated from PET/CT images with the threshold value of 41% of the SUVmax. The optimal cutoff point of progression-free survival(PFS) of SUVmax, MTV and TLG were investigated by using receiver operating characteristic(ROC) curve analysis. The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis, and COX proportional hazards model for multivariate analysis. Results The SUVmax, MTV and TLG of 85 patients were 23.9(16.3), 25.1(95.3) cm3, 424.4(1404.6), respectively. ROC curve showed that the area under the curce(AUC) of SUVmax, MTV and TLG were 0.610, 0.729 and 0.726(95% CI: 0.483 -0.736, P=0.109; 0.621 --0.838, P=0.001; 0.621 -0.831, P=0.001), respectively. The median SUVmax(23.9) was used as the cutoff points due to smaller AUC of SUVmax. The cutoff point of MTV was 39.1 cm3(sensitivity=73.1% and specificity=69.5%), and the cutoff point of TLG was 404.5(sensitivity=80.8% and specificity= 61.0%). Univariate analysis showed that Ann Arbor stage, β-2 MG, lactate dehydrogenase(LDH) level, bulky disease, international prognostic index(IPI), SUVmax, MTV and TLG were relative factors affecting PFS(χ2 =19.118, P=0.000; χ2=12.310, P=0.000; χ2=4.861, P=0.027; χ2=7.731, P=0.013; χ2=19.693, P=0.000; χ2=6.414, P=0.011; χ2=14.538, P=0.000; χ2=13.089, P=0.000), and Ann Arbor stage, β-2 MG, bulky disease, IPI, MTV and TLG were relative factors affecting overall survival(OS)(χ2 =14.550, P=0.000; χ2=5.473, P=0.019; χ2=5.643, P=0.018; χ2=15.943, P=0.000; χ2=13.877, P=0.000; χ2=12.677, P=0.000). As MTV and TLG measures correlated strongly, only TLG measures were used for multivariate analysis. LDH level and TLG were statistically significant predictors of PFS(RR=4.891, 95%CI=1.332-11.955, P=0.017; RR=0.195, 95%CI=0.058- 0.660, P=0.009), and IPI and TLG were statistically significant predictors of OS on multivariate analysis(RR=0.508, 95%CI=0.270–0.956, P=0.036; RR=0.433, 95%CI=0.227 – 0.826, P=0.011). Conclusions TLG in pretreatment 18F-FDG PET/CT is an independent prognostic factor for predicting progression-free survival and overall survival time in patients with DLBCL of stage Ⅱ-Ⅲ disease. TLG may be more useful than SUVmax for prognosisand has certainly reference value. Key words: Lymphoma, B cell; Positron emission tomography computed tomography; Fluorodeoxyglucose F18; Prognosis