Objective: To investigate the prognostic value of the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by pretreatment (18)F-FDG PET-CT in patients with stage Ⅲ~Ⅳ diffuse large B-cell lymphoma (DLBCL). Methods: Clinical data of 72 DLBCL patients with stage Ⅲ~Ⅳ disease undergoing a pretreatment PET-CT scan were retrospectively analyzed. SUVmax, MTV and TLG values of whole-body tumor were calculated from PET-CT images with a threshold of SUVmax 40% of tumor tissues. The optimal cutoff lines of SUVmax, MTV and TLG were obtained by ROC curve analysis. The Kaplan-Meier method and Log-rank test were used to perform univariate survival analysis, while Cox proportional hazards model was done for multivariate analysis. Results: The SUVmax, MTV and TLG of 72 patients were 21.64, 139.48 cm(3) and 1 413.77, respectively. The areas under the ROC curve (AUC) of SUVmax, MTV and TLG were 0.411 (95%CI=0.279~0.544, P=0.195), 0.688 (95%CI=0.566~0.811, P=0.006) and 0.526 (95%CI= 0.469~0.672, P=0.123), respectively. The median SUVmax (21.64) and TLG(1 413.77) were used as the cutoff lines due to smaller AUC. The cutoff point of MTV was 69.71 cm(3). For DLBCL patients of stage Ⅲ~Ⅳ disease, univariate analysis showed that SUVmax and TLG were not associated with the progression-free survival (PFS) and overall survival (OS) (P>0.05 for all). Multivariate analysis showed that National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) but not MTV was the independent prognostic predictor of PFS and OS (P<0.05 for all). And MTV was not the independent prognostic factor of PFS and OS for stage Ⅲ DLBCL (P>0.05 for all). Conclusions: For DLBCL patients with stage Ⅲ~Ⅳ disease, the prognostic value of SUVmax, MTV and TLG before treatment initiation are undetermined, and these indices cannot be used to predict the prognosis.
目的： 探讨治疗前(18)F-脱氧葡萄糖((18)F-FDG)正电子发射计算机断层扫描(PET-CT)显像中最大标准摄取值(SUVmax)、代谢体积(MTV)和病灶糖酵解总量(TLG)预测Ⅲ~Ⅳ期弥漫大B细胞淋巴瘤(DLBCL)患者预后的价值。 方法： 回顾性分析72例Ⅲ~Ⅳ期DLBCL患者的临床资料，患者治疗前均行(18)F-FDG PET-CT检查。以SUVmax的40%作为阈值，获得全身肿瘤的SUVmax、MTV和TLG。采用受试者工作特征(ROC)曲线和ROC曲线下面积(AUC)分析SUVmax、MTV和TLG预测患者无进展生存时间(PFS)的最佳临界值。采用Kaplan-Meier法和Log rank检验进行单因素生存分析，多因素生存分析采用Cox比例风险模型。 结果： 72例Ⅲ~Ⅳ期DLBCL患者的SUVmax、MTV和TLG分别为21.64、139.48 cm(3)和1 413.77。ROC曲线分析显示，SUVmax的AUC为0.411(95% CI为0.279~0.544，P=0.195)，MTV的AUC为0.688(95% CI为0.566~0.811, P=0.006)，TLG的AUC为0.526(95% CI为0.469~0.672，P=0.123)。由于SUVmax和TLG的AUC较小，以SUVmax和TLG的中位数21.64和1 413.77作为临界值；MTV的临界值为69.71 cm(3)。多因素分析显示，美国国立癌症综合网络国际预后指数为影响Ⅲ~Ⅳ期DLBCL患者无进展生存时间(PFS)和总生存时间(OS)的独立因素(均P<0.05)，而MTV与Ⅲ~Ⅳ期DLBCL患者的PFS和OS均无关(均P>0.05)；MTV与Ⅲ期DLBCL患者的PFS和OS均无关(均P>0.05)；SUVmax、MTV和TLG与Ⅳ期DLBCL患者的无进展生存率和总生存率均无关(均P>0.05)。 结论： 治疗前(18)F-FDG PET-CT的SUVmax、MTV和TLG在预测Ⅲ~Ⅳ期DLBCL患者预后的价值不明确，尚不能判断患者的预后。.
Keywords: Deoxyglucose; Lymphoma, B-cell; Prognosis; Tomography X -ray computed; Tomography emission-computed.