18F-FDG PET/CT Deauville评分和IHP标准在弥漫性大B细胞淋巴瘤疗效评估中的应用

摘要

目的 比较18F-脱氧葡萄糖(FDG) PET/CT Deauville评分和国际统一标准化项目(IHP)标准在弥漫性大B细胞淋巴瘤(DLBCL)疗程结束后疗效评估中的价值.方法 回顾性分析2010年2月至2018年6月间212例[男119例,女93例,平均年龄59.6(10～88)岁]疗程结束后行18F-FDG PET/CT评估疗效的DLBCL患者.分别采用IHP标准、Deauville评分3～5分(DC3)和Deauville评分4～5分(DC4)分析图像,以随访结果为“金标准”,分析3种标准的疗效评估效能.相关分析采用Spearman秩相关.进行Kaplan-Meier生存分析和Cox回归分析,探讨不同标准与无进展生存(PFS)、总生存(OS)的关系.结果 DC4评估疗效的阳性预测值和准确性分别为96.8％(61/63)、94.3％ (200/212);IHP标准相应指标为75.3％(67/89)、87.7％ (186/212);DC3对应数据为82.9％(68/82)、92.0％(195/212).IHP标准与Deauville评分间存在正相关性(rs=0.926,P＜0.05).IHP标准阳性、DC3阳性与DC4阳性患者的2年PFS率分别为78.7％、76.5％、69.8％,阳性组与阴性组(95.6％、94.7％、97.2％)比较差异有统计学意义(x2=14.415、18.293与26.920,均P＜0.05);2年OS率差异也有统计学意义(x2 =9.597、11.149与17.416,均P＜0.05).Deauville评分为1、2、3、4、5分组的2年PFS率分别为95.3％、91.7％、93.3％、88.9％、55.6％,差异有统计学意义(x2=48.199,P＜0.05).多因素Cox回归分析结果表明Deauville评分与PFS密切相关(P＜0.05).结论 IHP标准、DC3与DC4均对淋巴瘤预后具有预测价值,DC4预测价值最优,且Deauville评分与疾病进展状态密切相关.%Objective To evaluate the diagnostic efficiency and prognostic value of 18F-fluorodeoxyglucose (FDG) PET/CT for response assessment after treatment in patients with diffuse large B-cell lymphoma (DLBCL) when using the Deauville criteria and International Harmonization Project (IHP) criteria.Methods A total of 212 patients (119 males,93 males,average age:59.6(10-88) years) with DLBCL from February 2010 to June 2018 were analyzed.All subjects underwent restaging PET/CT after treatment.Images were evaluated with the IHP criteria,Deauville score of 3-5 (DC3) and Deauville score of 4-5 (DC4).The diagnostic efficiency of the 3 criteria for treatment effect was assessed and follow-up results were used as the gold standard.Spearman rank correlation analysis was used.Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier analysis and Cox proportional hazards model.Results The positive predictive value and accuracy of DC4 for treatment effect evaluation were 96.8％(61/63) and 94.3％(200/212),those of IHP criteria were 75.3％(67/89) and 87.7％(186/212)respectively,and those of DC3 were 82.9％ (68/82) and 92.0％ (195/212) respectively.IHP criteria results and Deauville scores were correlated(rs =0.926,P＜0.05).The 2-year PFS rates in IHP-,DC3-and CD4-positive groups were 78.7％,76.5％ and 69.8％,respectively,and those in IHP-,DC3-and CD4-negative groups were significantly higher (95.6％,94.7％,97.2％;x2=14.415,18.293 and 26.920,all P＜0.05).The similar results were found for OS rates (x2 =9.597,11.149 and 17.416,all P＜0.05).The 2-year PFS rates in Deauville score of 1,2,3,4,5 groups were 95.3％,91.7％,93.3％,88.9％ and 55.6％ respectively (x2 =48.199,P＜0.05).Cox-regression analysis showed significant correlation between Deauville criteria and 2-year PFS rate (P＜0.05).Conclusions PET/CT with DC4,DC3 and IHP criteria have high predictive values for treatment outcome,and DC4 is the best.Cox regression analysis shows significant risk of progression by Deauville criteria.