| Objective:Diffuse Large B-Cell Lymphoma（DLBCL）is a common invasive lymphoma with individualized prognosis.The existing prognostic indicators of DLBCL are deficient in imaging information,and DLBCL as a blood system disease,has the feature of systemic multiple lesions,so the assessment of the overall tumor burden is important.The purpose of this study was to determine the prognostic value of metabolic parameters in 18F-FDG PET/CT like total of total standardized uptake value（TSUVtotal）,total metabolic tumour volume（TMTV）and total lesion glycolysis（TLG）as a quantitative index on pre-treatment 18F-FDG PET/CT in patients with DLBCL.Methods:A total of 103 consecutive patients with DLBCL and baseline 18F-FDG PET/CT were retrospectively evaluated.All patients received standardized treatment.Patients were collected clinical data including the patient’s gender,age,Ann Arbor in installment,the number of lesions,ECOG PS score,lactate dehydrogenase（LDH）.Quantitative metabolic parameters,including TSUVtotal,TMTV and TLG using a41%of SUVmax as the threshold,were estimated by semi-automatic software program Beth Israel Fiji,combined with subsequent pathography and imaging data eliminate false positive lesions.Receiver operating characteristic curve（ROC）analysis was used to determine the optimal cut-off values for the metabolic parameters.Patient survival rates were derived from Kaplan-Meier curves and compared using the log-rank test.The relationships between study variables and patient survival were tested using Cox regression analysis.Results:（1）In this study,a total of 103 patients were enrolled,47 males and 56females,and 52 patients over 60 years old.The Ann Arbor staging results were as follows:stage I（n=11,10.7%）,stage II（n=18,17.5%）,stage III（n=13,12.6%）,and stage IV（n=61,59.2%）.There were 39（37.9%）patients with more than one external lymph node lesion,45（43.7%）patients with elevated LDH level,and 21 patients without clinical LDH level detection.Only 6 patients had an ECOG PS score of more than 1.（2）The median follow-up time was 28 months.ROC analysis showed that the optimal truncation values of TSUVtotal,TMTV and TLG for PFS were 470200.65,45.02 cm3 and 3893.42 cm3（P=0.008,P=0.004,P=0.008）,and the optimal truncation values of TSUVtotal,TMTV and TLG for OS were 730089.30,298.32 cm3 and6045.13cm3（P=0.081,P=0.065,P=0.081）,respectively.（3）In patients with a low TSUVtotal（<470200.65）,the 3-year progression free survival（PFS）rate was 80%and the overall survival（OS）rate was 89%,in contrast to 34%and 64%,respectively,in those with a high TSUVtotal（≥470200.65）.Patients with a low TMTV（<45.02cm3）had a 3-year PFS rate of 87%and an OS rate of 93%,while those with a high TMTV（≥45.02 cm3）had a 3-year PFS rate of 54%and an OS rate of 74%,Patients with a low TLG（<3893.42cm3）had a 3-year PFS rate of 80%and an OS rate of 89%,while those with a high TLG（≥3893.42cm3）had a 3-year PFS rate of 34%and an OS rate of 64%（4）.In the univariate analysis,Ann Arbor staging（P=0.029）,number of extraneous lesions（P=0.010）,ECOG PS score（P=0.004）,TSUVtotal（P<0.001）,TMTV（P=0.004）and TLG（P<0.001）were significantly correlated with patients PFS,while number of extraneous lesions（P=0.031）,ECOG PS score（P=0.003）,TSUVtotal（P=0.012）and TLG（P=0.012）were significantly correlated with patients OS,while TMTV showed no significant difference in OS（P=0.079）.TSUVtotal and TLG are linearly dependent covariables.In the multivariate Cox regression analysis,TMTV was an independent predictor of PFS（hazard ratio,HR,4.538,95%confidence interval,CI,1.046-19.694,P=0.043）.TSUVtotal and TLG were independent predictors of PFS（HR 3.721,95%CI 1.063-13.018,P=0.040）.TSUVtotal（P=0.465）、TMTV（P=0.548）and TLG（P=0.465）for OS prediction has no statistical significance.Conclusion:18F-FDG PET/CT tumor metabolic burden parameters TSUVtotal,TMTV and TLG have predictive value on DLBCL,no significant difference in OS,patients with high TSUVtotal,high MTV and high TLG had poor PFS,and tumor metabolic burden parameters TSUVtotal,TMTV and TLG are independent predictors of PFS in DLBCL. |
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