背景:发现代谢肿瘤面积(MTA)是前列腺癌的有希望的预测因子。然而,基于18F-FDGPET/CT的MTA在弥漫性大B细胞淋巴瘤(DLBCL)预后中的作用尚不清楚.这项研究旨在阐明MTA的预后意义,并评估其对一线R-CHOP方案治疗的DLBCL患者的国家综合癌症网络国际预后指数(NCCN-IPI)的增量价值。
方法:回顾性评估了280例新诊断的DLBCL患者和基线18F-FDGPET/CT数据。通过基于41%SUVmax阈值的半自动分割方法描绘病变,以估计半定量代谢参数,例如总代谢肿瘤体积(TMTV)和MTA。使用接收器工作特征(ROC)曲线分析来确定最佳截止值。无进展生存期(PFS)和总生存期(OS)是用于评估预后的终点。通过Kaplan-Meier曲线估算PFS和OS,并通过对数秩检验进行比较。
结果:单因素分析显示,高MTA患者,高TMTV和NCCN-IPI≥4与较差的PFS和OS相关(均P<0.0001)。多变量分析表明,MTA仍然是PFS和OS的独立预测因子[风险比(HR),2.506;95%置信区间(CI),1.337-4.696;P=0.004;和HR,1.823;95%CI,1.005-3.310;P=0.048],而TMTV不是。使用NCCN-IPI模型作为协变量的进一步分析显示,MTA和NCCN-IPI仍然是PFS的独立预测因子(HR,2.617;95%CI,1.494-4.586;P=0.001;和HR,2.633;95%CI,1.650-4.203;P<0.0001)和OS(HR,2.021;95%CI,1.201-3.401;P=0.008;和HR,3.869;95%CI,1.959-7.640;P<0.0001;分别)。此外,MTA用于将具有高NCCN-IPI风险评分的患者分为两组,结果显着不同。
结论:基于18F-FDGPET/CT和NCCN-IPI的治疗前MTA是接受R-CHOP治疗的DLBCL患者PFS和OS的独立预测因子。MTA对DLBCL患者的预后具有额外的预测价值,尤其是NCCN-IPI≥4的高危患者。此外,MTA和NCCN-IPI的联合应用可能有助于进一步改善风险分层和指导个体化治疗方案.
背景:这项研究在苏州大学附属第三医院伦理委员会进行了回顾性注册,注册号是批准号。155(批准日期:2022年5月31日)。
BACKGROUND: The metabolic tumour area (MTA) was found to be a promising predictor of prostate cancer. However, the role of MTA based on 18F-FDG PET/CT in diffuse large B-cell lymphoma (DLBCL) prognosis remains unclear. This study aimed to elucidate the prognostic significance of MTA and evaluate its incremental value to the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) for DLBCL patients treated with first-line R-CHOP regimens.
METHODS: A total of 280 consecutive patients with newly diagnosed DLBCL and baseline 18F-FDG PET/CT data were retrospectively evaluated. Lesions were delineated via a semiautomated segmentation method based on a 41% SUVmax threshold to estimate semiquantitative metabolic parameters such as total metabolic tumour volume (TMTV) and MTA. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values. Progression-free survival (PFS) and overall survival (OS) were the endpoints that were used to evaluate the prognosis. PFS and OS were estimated via Kaplan‒Meier curves and compared via the log-rank test.
RESULTS: Univariate analysis revealed that patients with high MTA, high TMTV and NCCN-IPI ≥ 4 were associated with inferior PFS and OS (P < 0.0001 for all). Multivariate analysis indicated that MTA remained an independent predictor of PFS and OS [hazard ratio (HR), 2.506; 95% confidence interval (CI), 1.337-4.696; P = 0.004; and HR, 1.823; 95% CI, 1.005-3.310; P = 0.048], whereas TMTV was not. Further analysis using the NCCN-IPI model as a covariate revealed that MTA and NCCN-IPI were still independent predictors of PFS (HR, 2.617; 95% CI, 1.494-4.586; P = 0.001; and HR, 2.633; 95% CI, 1.650-4.203; P < 0.0001) and OS (HR, 2.021; 95% CI, 1.201-3.401; P = 0.008; and HR, 3.869; 95% CI, 1.959-7.640; P < 0.0001; respectively). Furthermore, MTA was used to separate patients with high NCCN-IPI risk scores into two groups with significantly different outcomes.
CONCLUSIONS: Pre-treatment MTA based on 18F-FDG PET/CT and NCCN-IPI were independent predictor of PFS and OS in DLBCL patients treated with R-CHOP. MTA has additional predictive value for the prognosis of patients with DLBCL, especially in high-risk patients with NCCN-IPI ≥ 4. In addition, the combination of MTA and NCCN-IPI may be helpful in further improving risk stratification and guiding individualised treatment options.
BACKGROUND: This research was retrospectively registered with the Ethics Committee of the Third Affiliated Hospital of Soochow University, and the registration number was approval No. 155 (approved date: 31 May 2022).