【摘要】 目的 PET/CT是广泛应用于淋巴瘤疗效评价及预后评估的影像学技术,国际协作项目标准(international harmonization project criteria,IHPC)以及Deauville标准是基于视觉分析PET/CT图像的疗效评价标准。本研究旨在比较上述标准对于治疗结束后霍奇金淋巴瘤(Hodgkin lymphoma,HL)和非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)的疗效评价及预后评估价值,并进一步探讨治疗结束后完全缓解的弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)患者的预后影响因素。方法回顾性分析2010-01-28-2016-10-31天津医科大学总医院PET/CT中心行PET/CT检查、资料完整并确诊为淋巴瘤的70例患者临床资料,其中HL 23例,NHL 47例。所有患者化疗前及化疗结束后均行PET/CT显像,治疗结束后PET(end of treatment PET,ePET)/CT图像分别采用IHPC及Deauville标准进行评估,比较两者的疗效评价效能及预后评估价值。采用Kaplan-Meier生存分析法,进一步分析治疗结束后获得完全缓解的DLBCL患者的预后。结果 IHPC敏感性(sensitiveness,Se)为95.0%,特异性(specificity,Sp)为77.5%,阳性预测值(positive predictive value,PPV)为61.3%,阴性预测值(negative predictive value,NPV)为97.4%,准确性为81.4%,曲线下面积(area under the curve,AUC)为0.818。Deauville标准的Se为85.0%,Sp为88.0%,PPV为73.9%,NPV为93.6%,准确性为87.1%,AUC为0.933,两者AUC差异有统计学意义,Z=2.082,P=0.037。单因素Cox回归分析结果显示,性别、临床分期、IHPC和Deauville标准为HL以及NHL患者预后的有意义因素;多因素回归分析结果显示,IHPC以及Deauville标准为独立预后因素,IHPC的风险比(hazard ratios,HR)为6.61(95%CI:1.85~23.69,P=0.004),Deauville标准HR=9.14(95%CI:2.86~29.20,P<0.001)。完全缓解(complete response,CR)的DLBCL患者预后分析结果显示,Deauville标准评价为阴性的27例DLBCL患者中,组织学类型为生发中心(germinal center B cell,GCB)患者预后优于非生发中心(non-germinal centre B cells,non-GCB),两组生存比较差异有统计学意义,χ2=9.954,P=0.02。结论对于不同类型的HL和NHL,IHPC与Deauville标准均具有疗效评价以及预后评估价值,Deauville标准在一定程度上优于IHPC。治疗结束后完全缓解的DLBCL患者中组织学类型为non-GCB亚型的患者预后不良。更多还原

【Abstract】 OBJECTIVE PET/CT is a widely used imaging technique for evaluating the response and prognosis of lymphoma.IHPC and Deauville criteria are the visual method to assess response based on the PET/CT images.The current study aimed to compare the value of Deauville criteria and IHPC to evaluate the response and prognosis at the end of treatment of HL and NHL patients and further stratification by clinical and biological markers for DLBCL patients Methods A total of seventy patients from January 28 2010 to October 31 2016 were retrospectively enrolled in this study.All patients underwent PET/CT imaging before and after chemotherapy.End of treatment FDG PET/CT images were interpreted with Deauville criteria and IHPC to determine which criteria best predicted the result after chemotherapy.KaplanMeier survival analysis was used to further stratify survival outcomes of DLBCL patients with complete remission.RESULTS(1)Response assement:IHPC:Se was 95.0%,Sp was 77.5%,PPVwas 61.3%,NPV was 97.4%,accuracy was81.4% and the AUC was 0.818.Deauville criteria:Se was 85.0%,Sp was 88.0%,PPV was 73.9%,NPV was 93.6%,accuracy was 87.1%,and the AUC was 0.933.The difference of AUC was significant(Z=2.082,P=0.037).(2)Prognosis assement:Univariate Cox regression analysis showed that sex,cilinical stage,IHPC and Deauville criteria were significant for the prognosis of patients with HL and NHL,however,IHPC and Deauville criteria were independent prognostic factors,HR of IHPC was 6.61(95%CI:1.85-23.69,P=0.004),HR of Deauville criteria was 9.14(95%CI:2.86-29.20,P<0.001),respectively.(3)Prognostic analysis of DLBCL patients with complete remission:27 DLBCL patients achieved complete remission.The prognosis of patients with GCB was better than that of non-GCB,the difference of Log-rank test between the two groups was statistically significant(χ2=9.954,P=0.02).CONCLUSIONS Deauville criteria outperformed IHPC in the evaluation of response assement and prognosis at the end of treatment of HL and NHL patients.The prognosis of complete remission patients with non-GCB subtype was poor.更多还原