Objective: To investigate the prognostic value of bone marrow uptake pattern in 18F-deoxyglucose (18F-FDG) PET/CT imaging before diffuse large B-cell lymphoma (DLBCL) treatment.
Methods: The clinical data of 156 patients with DLBCL were retrospectively analyzed. All patients underwent bone marrow biopsy, bone marrow smear, flow cytometry and 18F-FDG PET/CT scan before treatment. Taking normal liver 18F-FDG uptake as the standard, the bone marrow uptake patterns of patients were divided into three types: focal increased bone marrow uptake (fPET+), diffusely increased bone marrow uptake (dPET+), and normal bone marrow uptake (nPET). Survival analysis was performed using the Kaplan-Meier method, log-rank test was used for comparison of differences between groups, and multivariate Cox regression analysis was used to identify risk factors associated with prognosis.
Results: Among the 156 patients, 17 cases were fPET+, 28 cases were dPET+, and 111 cases were nPET. Clinical diagnosis of bone marrow infiltration (BMI) was positive in 21 cases and negative in 135 cases. There were 62 cases of recurrence and progression, and 18 cases of death. Univariate analysis showed that Ann Arbor stage III/IV, B symptoms, NCCN-IPI score, lactate dehydrogenase (LDH), BMI+ and fPET+ were associated with progression-free survival (PFS) (all P < 0.05), while Ann Arbor stage III/IV, NCCN-IPI score, LDH, BMI+ and fPET+ were associated with overall survival (OS) (all P < 0.05). Multivariate analysis showed that Ann Arbor stage III/IV, LDH and fPET+ were independent predictors of PFS (all P < 0.05). There were no independent predictors of OS in multivariate analysis.
Conclusion: The bone marrow uptake pattern of 18F-FDG imaging in DLBCL patients before treatment has a predictive value for DLBCL, while fPET+ is an independent risk factor for PFS.
题目: 基线PET/CT显像骨髓18F-FDG摄取模式预测DLBCL预后的价值.
目的: 探讨弥漫大B细胞淋巴瘤（DLBCL）治疗前18F-脱氧葡萄糖（18F-FDG）PET/CT显像中骨髓摄取模式对预测DLBCL患者预后的价值。.
方法: 回顾性分析156例DLBCL患者的临床资料，所有患者治疗前均行骨髓活检、骨髓涂片、流式细胞分析和18F-FDG PET/CT扫描。以正常肝脏18F-FDG摄取为标准，将患者骨髓摄取模式分为骨髓摄取局灶型增高（fPET+）、骨髓摄取弥漫型增高（dPET+）及骨髓摄取正常型（nPET）。生存分析采用Kaplan-Meier法，组间差异比较采用log-rank检验，采用多因素Cox回归分析确定与预后相关的危险因素。.
结果: 156例患者中，fPET+ 17例，dPET+ 28例，nPET 111例。临床诊断骨髓浸润阳性21例，阴性135例。复发进展62例，死亡18例。单因素分析显示，Ann Arbor分期Ⅲ/Ⅳ期、B症状、NCCN-IPI评分、乳酸脱氢酶、骨髓浸润及fPET+与患者无进展生存期（PFS）有关（均P < 0.05）；Ann Arbor分期Ⅲ/Ⅳ期、NCCN-IPI评分、乳酸脱氢酶、骨髓浸润及fPET+与患者总生存期（OS）有关（均P < 0.05）；多因素分析显示，Ann Arbor分期III/IV期、乳酸脱氢酶和fPET+（均P < 0.05）是PFS独立预测因子。在OS的多变量分析中没有独立预测因子。.
结论: DLBCL患者治疗前18F-FDG显像中骨髓摄取模式对预后有预测价值，fPET+是患者PFS的独立危险因素。.
Keywords: 18F-deoxyglucose; bone marrow biopsy; diffuse large B-cell lymphoma; positron emission tomography/computed tomography; prognosis.