<sup>18</sup>F-FDG PET/CT定量参数与DLBCL预后转归的关联性及预测价值分析

doi:10.3969/j.issn.1006-6233.2025.06.13

摘要
图/表
参考文献
相关文章 (2)

全文: PDF (1435 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的: 分析¹⁸F-脱氧葡萄糖正电子发射计算机断层成像(¹⁸F-FDG PET/CT)定量参数与弥漫大B细胞淋巴瘤(DLBCL)预后转归的关联性及预测价值。方法: 选取2020年5月至2022年5月新疆医科大学第一附属医院200例DLBCL患者,均行¹⁸F-FDG PET/CT检查获取定量参数。随访2年,根据预后情况分为预后不良组和预后良好组,比较两组一般资料、¹⁸F-FDG PET/CT定量参数[最大标准摄取值(SUV_max)、平均标准摄取值(SUV_mean)、最大病灶肿瘤代谢体积(MTV_max)、总肿瘤代谢体积(MTV_sum)、最大病灶糖酵解(TLG_max)、总糖酵解(TLG_sum)、最大病灶的最大直径(D_max)],采用Logistic回归分析预后不良的影响因素,根据常规影响因素建立常规Logistic预测模型,常规影响因素联合¹⁸F-FDG PET/CT定量参数建立新Logistic预测模型,并采用受试者工作特征曲线(ROC)分析两种Logistic预测模型的预测价值。结果: 192例完成随访的患者中,预后不良患者81例(复发42例,进展23例,死亡16例),预后良好患者111例。预后不良组Ann-Arbor分期Ⅲ~Ⅳ期占比、国际预后指数(IPI)≥4分占比、乳酸脱氢酶/白蛋白比值(LAR)及MTV_max、MTV_sum、TLG_max、TLG_sum、D_max高于预后良好组,白蛋白/纤维蛋白原比值(AFR)低于预后良好组,差异有统计学意义(P<0.05);Logistic回归分析显示,Ann-Arbor分期(OR=2.129,95%CI:1.426~3.180)、IPI(OR=2.640,95%CI:1.731~4.025)、AFR(OR=0.383,95%CI:0.267~0.549)、LAR(OR=1.420,95%CI:1.143~1.765)、MTV_max(OR=1.503,95%CI:1.206~1.873)、MTV_sum(OR=1.445,95%CI:1.185~1.761)、TLG_max(OR=1.487,95%CI:1.193~1.854)、TLG_sum(OR=1.455,95%CI:1.175~1.802)、D_max(OR=1.519,95%CI:1.220~1.891)均为DLBCL患者预后不良的影响因素(P<0.05);构建Logistic预测模型,ROC分析显示,新模型预测DLBCL患者预后不良的曲线下面积(AUC)为0.941(95%CI:0.897~0.970),优于常规模型预测效能(P<0.05)。结论: ¹⁸F-FDG PET/CT定量参数MTV_max、MTV_sum、TLG_max、TLG_sum、D_max均是DLBCL患者预后不良的影响因素,与常规指标联合可明显提高对预后不良风险的预测价值,可作为临床预测预后的新方案,并指导临床决策。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李毓斌
	张奇洲
	李肖红

关键词 ：弥漫大B细胞淋巴瘤, ¹⁸F-脱氧葡萄糖, 正电子发射计算机断层成像, 定量参数, 预后转归

Abstract：Objective: To analyze the correlation and predictive value of quantitative parameters of ¹⁸F-fluorodeoxyglucose positron-emission tomography compared with computed tomography (¹⁸F-FDG PET/CT) with the prognosis and outcome of diffuse large B-cell lymphoma (DLBCL). Methods: A total of 200 DLBCL patients from The First Affiliated Hospital of Xinjiang Medical University from May 2020 to May 2022 were selected. All patients underwent ¹⁸F-FDG PET/CT examination to obtain quantitative parameters. After a 2-year follow-up, patients were divided into a poor prognosis group and a good prognosis group according to their prognosis. The general information and ¹⁸F-FDG PET/CT quantitative parameters [maximum standard uptake value (SUV_max), average standard uptake value (SUV_mean), maximum metabolic tumor volume (MTV_max), total metabolic tumor volume (MTV_sum), maximum glycolysis (TLG_max), total glycolysis (TLG_sum), maximum diameter of the largest lesion (D_max)] were compared between the two groups. Logistic regression analysis was used to analyze the factors affecting poor prognosis. A conventional logistic prediction model was established based on conventional influencing factors. A new logistic prediction model was established by combining conventional influencing factors with quantitative parameters of ¹⁸F-FDG PET/CT. The predictive value of the two logistic prediction models was analyzed using the receiver operating characteristic (ROC) curve. Results: Among the 192 patients who completed follow-up, 81 patients had a poor prognosis (42 relapsed, 23 progressed, and 16 died), and 111 patients had a good prognosis. The proportion of Ann-Arbor stage Ⅲ~Ⅳ, the proportion of International Prognostic Index (IPI) score ≥4, the lactate dehydrogenase/albumin ratio (LAR), and the MTV_max, MTV_sum, TLG_max, TLG_sum, D_max in the poor prognosis group were higher than those in the good prognosis group, while the albumin/fibrinogen ratio (AFR) was lower than that in the good prognosis group, with statistically significant differences (P<0.05). Logistic regression analysis showed that Ann-Arbor staging (OR=2.129, 95%CI: 1.426~3.180), IPI (OR=2.640, 95%CI: 1.731~4.025), AFR (OR=0.383, 95%CI: 0.267~0.549), LAR (OR=1.420, 95%CI: 1.143~1.765), MTV_max (OR=1.503, 95%CI: 1.206~1.873), MTV_sum (OR=1.445, 95%CI: 1.185~1.761), TLG_max (OR=1.487, 95%CI: 1.193~1.854), TLG_sum (OR=1.455, 95%CI: 1.175~1.802), D_max (OR=1.519, 95%CI: 1.220~1.891) were all factors affecting the poor prognosis of DLBCL patients (P<0.05). A logistic prediction model was constructed, and ROC analysis showed that the area under the curve (AUC) of the new model for predicting poor prognosis in DLBCL patients was 0.941 (95%CI: 0.897~0.970), which was superior to the predictive performance of conventional models (P<0.05). Conclusion: The ¹⁸F-FDG PET/CT quantitative parameters of MTV_max, MTV_sum, TLG_max, TLG_sum, and D_max are all factors influencing the poor prognosis of patients with DLBCL, and the combination of them with conventional indices can significantly increase the predictive value of the risk of poor prognosis, which can be used as a new protocol for clinical prediction of prognosis and guide clinical decision-making.

Key words： Diffuse large B-cell lymphoma ¹⁸F-fluorodeoxyglucose Positron-emission tomography compared with computed tomography Quantitative parameters Prognostic outcome

基金资助:新疆维吾尔自治区自然科学基金资助项目,(编号:2019D01C307)

通讯作者: 李肖红

引用本文:

李毓斌, 张奇洲, 李肖红. ¹⁸F-FDG PET/CT定量参数与DLBCL预后转归的关联性及预测价值分析[J]. 河北医学, 2025, 31(6): 947-953.
LI Yubin, ZHANG Qizhou, LI Xiaohong. Correlation and Predictive Value Analysis of ¹⁸F-FDG PET/CT Quantitative Parameters with the Prognosis and Outcomes of DLBCL. HeBei Med, 2025, 31(6): 947-953.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.06.13 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I6/947

[1] Shi YF,Xu Y,Shen HF,et al.Advances in biology,diagnosis and treatment of DLBCL[J].Ann Hematol,2024,103(9):3315-3334.
[2] Evangelista L,Crimi F,Visentin A,et al.[18F] FDG PET/CT and PET/MR in patients with adrenal lymphoma:a systematic review of literature and a collection of cases[J].Curr Oncol,2022,29(10):7887-7899.
[3] Sathyamurthy I,Elangovan I.18F-FDG PET/CT in reclassifying the probable diagnosis of IE-A review[J].Indian Heart,2024,76(1):10-15.
[4] 中华人民共和国国家卫生健康委员会.淋巴瘤诊疗规范(2018年版)[J].肿瘤综合治疗电子杂志,2019,5(4):50-71.
[5] Burggraaff CN,Eertink JJ,Lugtenburg PJ,et al.¹⁸F-FDG PET improves baseline clinical predictors of response in diffuse large B-cell lymphoma:the HOVON-84 study[J].Nucl Med,2022,63(7):1001-1007.
[6] Haidar M,Kassas M,Chehade F,et al.The role of 18 F-FDG-PET/CT in the management of differentiated thyroid cancer[J].Nucl Med Commun,2023,44(11):1046-1052.
[7] Lodi Rizzini E,Repaci A,Tabacchi E,et al.Impact of ¹⁸F-FDG PET/CT on clinical management of suspected radio-Iodine refractory differentiated thyroid cancer (RAI-R-DTC)[J].Diagnostics (Basel),2021,11(8):1430-1430.
[8] Cartron G,Bachy E,Tilly H,et al.Randomized phase Ⅲ trial evaluating subcutaneous rituximab for the first-line treatment of low-tumor burden follicular lymphoma:results of a LYSA study[J].Clin Oncol,2023,41(19):3523-3533.
[9] Sachpekidis C,Enqvist O,Ulén J,et al.Application of an artificial intelligence-based tool in[18F] FDG PET/CT for the assessment of bone marrow involvement in multiple myeloma[J].Eur Nucl Med Mol Imaging,2023,50(12):3697-3708.
[10] Londalen A,Blakkisrud J,Revheim ME,et al.FDG PET/CT and dosimetric studies of 177lu-lilotomab satetraxetan in a first-in-human trial for relapsed indolent non-hodgkin lymphoma-are we hitting the target[J].Mol Imaging Biol,2022,24(5):807-817.
[11] 朱丽丽,赵汉青,郭莉莉,等.¹⁸F-FDG PET/CT参数预测弥漫大B细胞淋巴瘤中期疗效的应用研究[J].徐州医科大学学报,2022,42(5):369-374.
[12] 任吉莲,崔灵芝,郝小夏,等.miR-21、miR-191与弥漫性大B细胞淋巴瘤患者临床分期的相关性[J].中国实验血液学杂志,2023,31(1):115-119.
[13] Chen HZ,Zhong QF,Zhou Y,et al.Enhancement of the International prognostic index with β2-microglobulin,platelet count and red blood cell distribution width:a new prognostic model for diffuse large B-cell lymphoma in the rituximab era[J].BMC Cancer,2022,22(1):583-583.
[14] 赵金,黄涛,刘鑫.乳酸脱氢酶与白蛋白比值及免疫炎症生物标志物预测转移性结直肠癌预后的临床意义[J].临床肿瘤学杂志,2024,29(3):271-276.