Predictive value of interim 18F-FDG PET/CT in the efficacy and prognosis of patients with stage Ⅲ/Ⅳ extranodal diffuse large B-cell lymphoma
Objective To analysis the value of four evaluation indicators based on interim 18F-fluorodeoxyglucose(FDG)PET/CT(iPET/CT)in predicting the response to primary chemotherapy and prognosis of patients with stage Ⅲ/Ⅳ extranodal diffuse large B-cell lymphoma(EN-DLBCL).Methods A retrospective analysis was conducted on the imaging and clinical data of 56 newly diagnosed patients(27 males and 29 females;aged 27-28 years old with a median age of 68.5)with stage Ⅲ/Ⅳ EN-DLBCL confirmed by histopathological examination or follow-up in Beijing Hospital from May 2011 to April 2020.Follow-up was performed through the hospital's electronic medical record system or phone call.The receiver operating characteristic(ROC)curve was used to select the optimal cut-off for the maximum standardized uptake value of iPET/CT lesions(iSUVmax),the reduction percentage of lesions'SUVmax on interim and baseline PET/CT(△SUVmax％),and the ratio of lesions'SUVmax to liver SUVmax(iLLR).Patients divided into groups using the optimal cutoff and the interim Deauville 5-point scale(DS).The predictive value of iPET/CT indicators on the efficacy and prognosis of primary chemotherapy in patients with stage Ⅲ/Ⅳ EN-DLBCL was analyzed.x2 test was employed to compare the count data.Kaplan-Meier method and Log-rank test were applied to analyze the patients'2-year progression-free survival(PFS)rates,overall survival(OS)rates,and differences between groups.Univariate and multivariate Cox proportional risk regression analysis were utilized to analyze the predictive value of iSUVmax,△SUVmax％,iLLR,and DS for the efficacy and prognosis of primary chemotherapy in patients with stage Ⅲ/Ⅳ EN-DLBCL.Results At the end of primary chemotherapy,31 patients(55.4％)achieved complete remission(CR).The CR rates in the iSUVmax＜4.9,△SUVmax％≥87.0％,iLLR＜1.31,and DS 1-3 groups were higher than those in the iSUVmax≥4.9,△SUVmax％＜87.0％,iLLR≥1.31,and DS 4-5 groups(74.2％(23/31)vs.32.0％(8/25),76.2％(16/21)vs.42.9％(15/35),67.6％(23/34)vs.36.4％(8/22),and 76.0％(19/25)vs.38.7％(12/31)),the differences were statistically significantly(x2=9.970,5.901,5.290,7.787;all P＜0.05).The follow-up time was 4-103 months with a median time of 22 months.At the end of the follow-up,19 patients(33.9％)had progressed,relapsed,or died.The 2-year PFS rates in the iSUVmax＜4.9,iLLR＜1.63,and DS 1-3 groups(83.9％,83.7％,and 84.0％)were significantly higher than those in the iSUVmax≥4.9,iLLR≥1.63,and DS 4-5 groups(50.4％,37.6％,and 57.5％),the differences were statistically significantly(x2=6.117,10.478,4.116;all P＜0.05).The 2-year OS rate in the iLLR＜1.63 group(90.3％)was significantly higher than that in the iLLR≥1.63 group(67.4％),the difference was statistically significantly(x2=5.220,P＜0.05).Univariate Cox proportional risk regression analysis showed that iSUVmax and iLLR were predict factors for patients'PFS time(HR=2.883(95％CI:1.124-7.398),3.344(95％CI:1.339-8.353);both P＜0.05),and iLLR was an independent predict factor of patients'OS time(HR=4.445(95％CI:1.266-15.607),P＜0.05).Furthermore,multivariate Cox proportional risk regression analysis confirmed that iLLR was the independent predict factor of PFS and OS time in patients with stage Ⅲ/Ⅳ EN-DLBCL(HR=3.344(95％CI:1.339-8.353),4.445(95％CI:1.266-15.607);both P＜0.050).Conclusions The four evaluation indicators of iPET/CT in patients with stage Ⅲ/Ⅳ EN-DLBCL can predict whether CR can be achieved at the end of primary chemotherapy.iLLR can be considered as an independent predict factor of patients'PFS and OS time.
Lymphoma,large B cell,extranodalFluorodeoxyglucose F1 8Positron-emission tomographyTomography,X-ray computedMaximum standardized uptake valuePrognosisDeauville 5-point scaleEfficacy
NETL
NSTL
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