Background: This study assessed the prognostic value of tumor burden in bone marrow (BM) and total disease (TD), as depicted on 18F-FDG PET/CT in 140 DLBCL patients, for complete remission after first-line systemic treatment (iCR) and 3- and 5-year overall survival (OS3 and OS5). Methods: Baseline 18F-FDG PET/CT scans of 140 DLBCL patients were segmented to quantify metabolic tumor volume (MTV), total lesion glycolysis (TLG), and SUVmax in BMI, findings elsewhere (XL), and TD. Results: Bone marrow involvement (BMI) presented in 35 (25%) patients. Median follow-up time was 47 months; 79 patients (56%) achieved iCR. iCR was significantly associated with TD MTV, XL MTV, BM PET positivity, and International Prognostic Index (IPI). OS3 was significantly worse with TD MTV, XL MTV, IPI, and age. OS5 was significantly associated with IPI, but not with MTVs and TLGs. Univariate factors predicting OS3 were XL MTV (hazard ratio [HR] = 1.29), BMI SUVmax (HR = 0.56), and IPI (HR = 1.92). By multivariate analysis, higher IPI (HR = 2.26) and BMI SUVmax (HR = 0.91) were significant independent predictors for OS3. BMI SUVmax resulted in a negative coefficient and hence indicated a protective effect. Conclusions: Baseline 18F-FDG PET/CT MTV is significantly associated with survival. BMI identified on 18F-FDG PET/CT allows appropriate treatment that may improve survival.
背景：本研究评估了140例弥漫性大B细胞淋巴瘤（DLBCL）患者中，通过18F-FDG PET/CT显示的骨髓（BM）及全身总病灶（TD）肿瘤负荷对一线系统治疗后完全缓解（iCR）以及3年和5年总生存期（OS3和OS5）的预后价值。方法：对140例DLBCL患者的基线18F-FDG PET/CT图像进行分割，以量化骨髓病灶（BMI）、其他部位病灶（XL）及全身总病灶（TD）的代谢肿瘤体积（MTV）、病灶糖酵解总量（TLG）和最大标准化摄取值（SUVmax）。结果：35例（25%）患者存在骨髓浸润。中位随访时间为47个月；79例（56%）患者达到iCR。iCR与TD MTV、XL MTV、BM PET阳性及国际预后指数（IPI）显著相关。TD MTV、XL MTV、IPI和年龄较高者OS3显著较差。OS5与IPI显著相关，但与MTV和TLG无显著关联。预测OS3的单因素包括XL MTV（风险比[HR] = 1.29）、BMI SUVmax（HR = 0.56）和IPI（HR = 1.92）。多因素分析显示，较高的IPI（HR = 2.26）和BMI SUVmax（HR = 0.91）是OS3的显著独立预测因子。BMI SUVmax系数为负值，提示其具有保护性效应。结论：基线18F-FDG PET/CT的MTV与生存期显著相关。通过18F-FDG PET/CT识别的骨髓浸润有助于制定可能改善生存期的适宜治疗方案。
肿瘤(癌症)患者之家