Evaluation of therapeutic effect and prognostic value of ¹⁸F-FDG PET/CT in different treatment nodes of DLBCL patients.

IF 3.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

EJNMMI Research Pub Date : 2024-02-19 DOI:10.1186/s13550-024-01074-w

Wenyu Zhao, Xiaodong Wu, Shuo Huang, Hui Wang, Hongliang Fu

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引用次数: 0

Abstract

Background: In the present study, we aimed to investigate the role of baseline (B), interim (I) and end-of-treatment (Eot) ¹⁸F-FDG PET/CT in assessing the prognosis of diffuse large B cell lymphoma (DLBCL), so as to identify patients who need intensive treatment at an early stage.

Methods: A total of 127 DLBCL patients (62 men; 65 women; median age 62 years) were retrospectively analyzed in this study. Baseline (n = 127), interim (n = 127, after 3-4 cycles) and end-of-treatment (n = 53, after 6-8 cycles) PET/CT images were re-evaluated; semi-quantitative parameters such as maximum standardized uptake value of lesion-to-liver ratio (SUVmax_(LLR)) and lesion-to-mediastinum ratio (SUVmax_(LMR)), total metabolic tumor volume (TMTV) and total metabolic tumor volume (TLG) were recorded. ΔTLG¹ was the change of interim relative to baseline TLG (I to B), ΔTLG² (Eot to B). ΔSUVmax and ΔTMTV were the same algorithm. The visual Deauville 5-point scale (D-5PS) has been adopted as the major criterion for PET evaluation. Visual analysis (VA) and semi-quantitative parameters were assessed for the ability to predict progression-free survival (PFS) and overall survival (OS) by using Kaplan-Meier method, cox regression and logistic regression analysis. When visual and semi-quantitative analysis are combined, the result is only positive if both are positive.

Results: At a median follow-up of 34 months, the median PFS and OS were 20 and 32 months. The survival curve analysis showed that advanced stage and IPI score with poor prognosis, ΔSUVmax_(LLR)¹ < 89.2%, ΔTMTV¹ < 91.8% and ΔTLG¹ < 98.8%, ΔSUVmax_(LLR)² < 86.4% were significantly related to the shortening of PFS in patient (p < 0.05). ΔSUVmax_(LLR)¹ < 83.2% and ΔTLG¹ < 97.6% were significantly correlated with the shortening of OS in patients (p < 0.05). Visual analysis showed that incomplete metabolic remission at I-PET and Eot-PET increased the risk of progress and death. In terms of predicting recurrence by I-PET, the combination of visual and semi-quantitative parameters showed higher positive predictive value (PPV) and specificity than a single index.

Conclusion: Three to four cycles of R-CHOP treatment may be a time point for early prediction of early recurrence/refractory (R/R) patients and active preemptive treatment. Combined visual analysis with semi-quantitative parameters of ¹⁸F-FDG PET/CT at interim can improve prognostic accuracy and may allow for more precise screening of patients requiring early intensive therapy.

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评估 18F-FDG PET/CT 在不同治疗节点的 DLBCL 患者中的治疗效果和预后价值。

研究背景本研究旨在探讨基线（B）、中期（I）和治疗末期（Eot）18F-FDG PET/CT在评估弥漫大B细胞淋巴瘤（DLBCL）预后中的作用，从而识别早期需要强化治疗的患者：本研究对127例DLBCL患者（62例男性；65例女性；中位年龄62岁）进行了回顾性分析。重新评估了基线（n = 127）、中期（n = 127，3-4 个周期后）和治疗末期（n = 53，6-8 个周期后）PET/CT 图像；记录了病灶与肝脏比值（SUVmax(LLR)）和病灶与纵隔比值（SUVmax(LMR)）的最大标准化摄取值、总代谢肿瘤体积（TMTV）和总代谢肿瘤体积（TLG）等半定量参数。ΔTLG1 是相对于基线 TLG 的中期变化（I 到 B），ΔTLG2 是相对于基线 TLG 的中期变化（Eot 到 B）。ΔSUVmax和ΔTMTV的算法相同。PET 评估的主要标准是多维尔 5 点目测量表（D-5PS）。采用 Kaplan-Meier 法、cox 回归法和 logistic 回归分析法评估了视觉分析（VA）和半定量参数预测无进展生存期（PFS）和总生存期（OS）的能力。将直观分析和半定量分析结合起来，只有两者均为阳性时，结果才为阳性：中位随访 34 个月，中位 PFS 和 OS 分别为 20 个月和 32 个月。生存曲线分析显示，晚期和 IPI 评分与预后不良有关，ΔSUVmax(LLR)1 1 1 (LLR)2 (LLR)1 1 结论：三至四个周期的 R-CHOP 治疗可能是早期预测早期复发/难治（R/R）患者和积极进行先期治疗的一个时间点。在中期结合 18F-FDG PET/CT 的半定量参数进行视觉分析可提高预后的准确性，并可更精确地筛选出需要早期强化治疗的患者。

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来源期刊

EJNMMI Research RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING&nb-

CiteScore

5.90

自引率

3.10%

发文量

审稿时长

13 weeks

期刊介绍： EJNMMI Research publishes new basic, translational and clinical research in the field of nuclear medicine and molecular imaging. Regular features include original research articles, rapid communication of preliminary data on innovative research, interesting case reports, editorials, and letters to the editor. Educational articles on basic sciences, fundamental aspects and controversy related to pre-clinical and clinical research or ethical aspects of research are also welcome. Timely reviews provide updates on current applications, issues in imaging research and translational aspects of nuclear medicine and molecular imaging technologies. The main emphasis is placed on the development of targeted imaging with radiopharmaceuticals within the broader context of molecular probes to enhance understanding and characterisation of the complex biological processes underlying disease and to develop, test and guide new treatment modalities, including radionuclide therapy.