■准确的风险分层可以改善淋巴瘤管理,但目前的体积18F-氟代脱氧葡萄糖(FDG)指标需要对体内所有病变进行耗时的分割.在这里,我们调查了测量单个最大病变的容易获得的代谢体积(MBV)和大体积病变糖酵解(BLG)的预后价值。
■研究对象是242例新诊断的II或III期弥漫性大B细胞淋巴瘤(DLBCL)患者的同质队列,这些患者接受了一线R-CHOP治疗。回顾性分析基线PET/CT的最大横径(MTD),总代谢性肿瘤体积(TMTV),总病变糖酵解(TLG),MBV,BLG。使用30%SUVmax作为阈值绘制卷。Kaplan-Meier生存分析和Cox比例风险模型评估了预测总体生存(OS)和无进展生存(PFS)的能力。
■在5.4年的中位随访期间(最长为12.7年),事件发生在85例患者中,包括进展,复发,和死亡(65例死亡,中位数为17.6个月)。接收器操作特性(ROC)分析确定了112cm3的最佳TMTV,88cm3的MBV,950的TLG和750的BLG。MBV高的患者更可能患有III期疾病;ECOG表现较差;IPI风险评分较高;LDH增加;SUVmax高,MTD,TMTV,TLG,BLG。Kaplan-Meier生存分析显示高TMTV(p=0.005和<0.001),MBV(均p<0.001),TLG(p<0.001和0.008),BLG(p=0.018和0.049)与显著恶化的OS和PFS相关。关于Cox多变量分析,年龄较大(>60岁;HR,2.74;95%CI,1.58-4.75;p<0.001)和高MBV(HR,2.74;95%CI,1.05-6.54;p=0.023)是OS较差的独立预测因子。年龄较大(危险比[HR],2.90;95%CI,1.74-4.82;p<0.001)和高MBV(HR,2.36;95%CI,1.15-6.54;p=0.032)也是PFS恶化的独立预测因子。此外,在≤60岁的科目中,高MBV仍然是OS较差的唯一显著独立预测因子(HR,4.269;95%CI,1.03-17.76;p=0.046)和PFS(HR,6.047;95%CI,1.73-21.11;p=0.005)。在患有III期疾病的受试者中,只有更大的年龄(HR,2.540;95%CI,1.22-5.30;p=0.013)和高MBV(HR,6.476;95%CI,1.20-31.9;p=0.030)与OS差显著相关,而年龄越大是PFS越差的唯一独立预测因子(HR,6.145;95%CI,1.10-4.17;p=0.024)。
■在接受R-CHOP治疗的II/III期DLBCL患者中,易于从单个最大病变获得的MBV可能提供临床有用的FDG体积预后指标。
UNASSIGNED: Accurate risk stratification can improve lymphoma management, but current volumetric 18F-fluorodeoxyglucose (FDG) indicators require time-consuming segmentation of all lesions in the body. Herein, we investigated the prognostic values of readily obtainable metabolic bulk volume (MBV) and
bulky lesion glycolysis (BLG) that measure the single largest lesion.
UNASSIGNED: The study subjects were a homogeneous cohort of 242 newly diagnosed stage II or III diffuse large B-cell lymphoma (DLBCL) patients who underwent first-line R-CHOP treatment. Baseline PET/CT was retrospectively analyzed for maximum transverse diameter (MTD), total metabolic tumor volume (TMTV), total lesion glycolysis (TLG), MBV, and BLG. Volumes were drawn using 30% SUVmax as threshold. Kaplan-Meier survival analysis and the Cox proportional hazards model assessed the ability to predict overall survival (OS) and progression-free survival (PFS).
UNASSIGNED: During a median follow-up period of 5.4 years (maximum of 12.7 years), events occurred in 85 patients, including progression, relapse, and death (65 deaths occurred at a median of 17.6 months). Receiver operating characteristic (ROC) analysis identified an optimal TMTV of 112 cm3, MBV of 88 cm3, TLG of 950, and BLG of 750 for discerning events. Patients with high MBV were more likely to have stage III disease; worse ECOG performance; higher IPI risk score; increased LDH; and high SUVmax, MTD, TMTV, TLG, and BLG. Kaplan-Meier survival analysis showed that high TMTV (p = 0.005 and < 0.001), MBV (both p < 0.001), TLG (p < 0.001 and 0.008), and BLG (p = 0.018 and 0.049) were associated with significantly worse OS and PFS. On Cox multivariate analysis, older age (> 60 years; HR, 2.74; 95% CI, 1.58-4.75; p < 0.001) and high MBV (HR, 2.74; 95% CI, 1.05-6.54; p = 0.023) were independent predictors of worse OS. Older age (hazard ratio [HR], 2.90; 95% CI, 1.74-4.82; p < 0.001) and high MBV (HR, 2.36; 95% CI, 1.15-6.54; p = 0.032) were also independent predictors of worse PFS. Furthermore, among subjects ≤60 years, high MBV remained the only significant independent predictor of worse OS (HR, 4.269; 95% CI, 1.03-17.76; p = 0.046) and PFS (HR, 6.047; 95% CI, 1.73-21.11; p = 0.005). Among subjects with stage III disease, only greater age (HR, 2.540; 95% CI, 1.22-5.30; p = 0.013) and high MBV (HR, 6.476; 95% CI, 1.20-31.9; p = 0.030) were significantly associated with worse OS, while greater age was the only independent predictor of worse PFS (HR, 6.145; 95% CI, 1.10-4.17; p = 0.024).
UNASSIGNED: MBV easily obtained from the single largest lesion may provide a clinically useful FDG volumetric prognostic indicator in stage II/III DLBCL patients treated with R-CHOP.