Study On The Correlation Between SUV And LDH In Non-Hodgkin's Lymphoma

Objective1. To investigate the correlation between standard uptake valve (SUV) of 18Fluorodeoxyglucose positron emission tomography/ computerized tomography (18F-FDG PET/CT) and clinicopathologic parameters in patients with non-Hodgkin's lymphoma (NHL).2. To verify the association between serum lactic dehydrogenase (LDH) and clinicpathologic parameters in NHL patients.3. To determine the value of using SUV and LDH in identifying aggressive lymphoma and indolent lymphoma.4. To analyze the relationship between SUV and LDH.5. To evaluate the worth of applying SUV and LDH in prognostic prediction.Methods278 cases of NHL undergone 18F-FDG PET/CT in the Department of Medical Oncology in Provincial and Municipal Hospital of Anhui Medical University from Jan. 2007 to Sep. 2010 were analyzed retrospectively. Among the 278 cases, 92 subjects were untreated NHL patients met the following criteria: hospitalized in our hospital, with intact data, pathologically confirmed and proceeded LDH test pretherapy. Data of SUV, LDH, gender, age, tumor staging, with or without B-symptoms, bone marrow involvement, expression of Ki67, malignant degree and pathological classification were collected, and overall survival (OS) of the patients between groups were followed-up. Then the correlation between SUV, LDH and clinicpathologic parameters like gender, age, tumor staging, B-symptoms, bone marrow invasion, extranodal involvement, expression of Ki67, malignant degree and pathological classification and so on were investigated. All analyses were conducted using SPSS version 17.0. Two-sample comparisons were performed using the Wilcoxon test. Receiver operating characteristic (ROC) curve analysis was used to evaluate the relation between SUV, LDH and malignant degree of NHL. The association between SUV and LDH were determined by Pearson correlation coefficients. Survival analysis was performed using the Kaplan-Meier method to detect the correlation between LDH levels and prognosis of NHL patients. Log Rank test was applied to compare the survive curve distribution, and a P value of less than 0.05 was considered statistically significant.Results1. Significant association was found between SUV and positive expression rate of Ki67 (P=0.010), while there was no statistically difference between SUV and clinicpathologic parameters like gender, age, tumor staging, B-symptoms, bone marrow invasion, extranodal involvement (P>0.05).2. Apparently, LDH was associated with positive expression rate of Ki67 (P=0.010), B-symptoms (P=0.002), and bone marrow invasion (P=0.015), while showed no significant difference between gender, age, tumor staging, and extranodal involvement (P>0.05).3. SUV was definitely related to malignant degree of NHL (P=0.001). Study on ROC curve demonstrated that the area under the curve (AUC) represented diagnosis efficacy of SUV to aggressive lymphoma was 0.738, the standard error was 0.053, P=0.000, 95% confidence interval (95% CI) was (0.635, 0.842), excluded 0.5. Optimized critical value from ROC showed SUV=9.0 (sensitivity was 73.0% and specificity was 58.6%).4. Same as SUV, LDH also was relavant to malignant degree of NHL (P=0.035). The AUC reflected diagnosis efficacy of SUV to aggressive lymphoma was 0.705, the standard error was 0.060, P=0.002, 95% CI was (0.588, 0.823), excluded 0.5. The optimized critical value from ROC showed LDH=195 (sensitivity was 79.4% and specificity was 62.1%).5. After Spearman rank correlation analysis, there is a positive relationship between SUV and LDH (r=0.400, P<0.05). 6. In group with SUV>9, the median survival was 23 months; while in group with SUV≤9, the median survival was 28 months. Survival curves of the two groups were described by Kaplan-Meier method, and then the survival analysis was performed using Log Rank test with a result of p=0.243. There was no statistically difference between two groups'survival distribution.7. The median survival in group with LDH>195 was 23 months; while in group with SUV≤195 was 28 months. Survival curves of the two groups were described by Kaplan-Meier method, and then the survival analysis was performed using Log Rank test with a result of p=0.039. The difference between two groups'survival distribution was statistically significant.Conclusions1. SUV was significantly associated with positive expression rate of Ki67 and malignant degree of NHL.2. LDH was closely related to B-symptoms, bone marrow invasion, positive expression rate of Ki67and malignant degree of lymphoma in NHL patients.3. Just like LDH, SUV could also be used as one reference index to judge the malignant degree of NHL.4. There was a positive correlation between SUV and LDH.5. Both SUV and LDH could be used in prognostic prediction.