Objective: To evaluate the prognostic value of (18)F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) in patients with diffuse large B cell lymphoma (DLBCL) undergoing autologous hematopoietic stem cell transplantation (auto-HSCT). Methods: Forty-eight patients with DLBCL treated at Peking University Cancer Hospital between November 2010 and December 2014 were assessed. All patients underwent PET/CT scanning prior to or after auto-HSCT. Correlation analysis was done based upon patients characteristics, PET/CT scan results and survival. Results: ①Among 48 patients, 27 was male, 21 female, median age was 43 (17-59) years old. ② Patients with negative pre-auto-HSCT PET/CT assessment demonstrated significantly better 3-year progression free survival (PFS) (87.1% vs 53.3%, χ(2)=7.02, P=0.019) and overall survival (OS) (90.3% vs 60.0%, χ(2)=6.51,P=0.022) than patients with positive pre-auto-HSCT PET/CT assessment. Three-year PFS (94.1% vs 30.0%, χ(2)=22.75, P=0.001) and OS (97.1% vs 40.0%, χ(2)=21.09, P=0.002) were also significantly different between patients with negative and positive post-auto-HSCT PET/CT assessment. ③ Multivariate analysis indicated a significant association of PFS (HR=13.176, P=0.005) and OS (HR=20.221, P=0.007) with post-auto-HSCT PET/CT assessment. Number of prior treatment regimens was associated with PFS (HR=10.039, P=0.040). ④ Harrell's C index revealed that the value of combined use of number of prior treatment regimens and post-auto-HSCT PET/CT assessment was superior to either one used alone in PFS (Harrell's C values were 0.976, 0.869 and 0.927 in combined use, number of prior treatment regimens and post-auto-HSCT PET/CT assessment, respectively), and the combined use of ECOG performance status and post-auto-HSCT PET/CT assessment significantly increased the Harrell's C index in OS (Harrell's C values were 0.973, 0.711 and 0.919 in combined use, ECOG performance status and post-auto-HSCT PET/CT assessment, respectively). Conclusions: Post-auto-HSCT PET/CT assessment is the main predictor of outcomes in DLBCL patients receiving auto-HSCT. Combined use of post-auto-HSCT PET/CT assessment and number of prior treatment regimens and ECOG performance status is a better prognostic tool in patients with DLBCL undergoing transplantation.
目的： 探讨(18)F-FDG PET-CT评估在接受auto-HSCT的弥漫大B细胞淋巴瘤（DLBCL）患者中的预后价值。 方法： 回顾性分析2010年11月至2014年12月在北京大学肿瘤医院接受auto-HSCT的48例DLBCL患者资料，所有患者移植前或者移植后行PET-CT检查，结合患者基本临床特征及生存进行相关性分析。 结果： ①48例患者中，男27例，女21例，中位年龄为43（17~59）岁。②移植前PET-CT评估阴性和阳性患者的3年无进展生存（PFS）率分别为87.1%和53.3%（χ(2)=7.02，P=0.019），3年总生存（OS）率分别为90.3%和60.0%（χ(2)=6.51，P=0.022）；移植后两组患者的3年PFS率分别为94.1%和30.0%（χ(2)=22.75，P=0.001），3年OS率分别为97.1%和40.0%（χ(2)=21.09，P=0.002）。③多因素分析结果显示，移植后PET-CT评估阳性是影响患者PFS（HR=13.176，P=0.005）和OS（HR=20.221，P=0.007）的预后不良因素；移植前治疗方案数与PFS相关（HR=10.039，P=0.040）。④Harrell’s C值显示移植后PET-CT评估与移植前治疗方案数联合使用预测PFS的价值优于单独使用（联合使用、移植前治疗方案数、移植后PET-CT评估的Harrell’s C值分别为0.976、0.869、0.927）；移植后PET-CT与ECOG体力状态评分联合使用能更好预测OS（联合使用、ECOG体力状态评分、移植后PET-CT评估的Harrell’s C值分别为0.973、0.711、0.919）。 结论： 移植后PET-CT评估在接受auto-HSCT的DLBCL患者中有重要预后作用，移植后PET-CT评估联合移植前治疗方案数以及ECOG体力状态评分可能能够更好地预测患者预后。.
Keywords: Fluorodeoxyglucose F18; Hematopoietic stem cell transplantation; Lymphoma, large B-cell, diffuse; Positron-emission tomography and computed tomography.