Clinical Study Of 18F-FDG PET-CT In The Mid-Term Evaluation Of Diffuse Large B-Cell Lymphoma

Objective: Diffuse large B cell lymphoma(DLBCL)is the most common non Hodgkin's lymphoma in China.Its clinical characteristics,response and prognosis have obvious heterogeneity.About 40% of patients will still have primary drug resistance,relapse or progression after the first-line chemotherapy intervention,with poor prognosis.The commonly used CT,MRI and B-ultrasonic examination can not objectively judge the therapeutic effect in the evaluation of the curative effect after the mid-term treatment.PET-CT can reflect the therapeutic effect of lymphoma at molecular level.At present,there are few studies on the efficacy and prognosis of PETCT in the treatment of diffuse large B-cell lymphoma in the middle stage,and on the guidance of the later treatment.This project is to summarize and explore the role and value of PET-CT in the mid-term evaluation of the therapeutic effect of DLBCL,and in guiding the late clinical treatment.Methods: The purpose of this study is to collect 100 patients with diffuse large B lymphoma,and to make statistics of each chemotherapy plan,pathology,LDH,size change of lymph nodes(check superficial lymph nodes or tumor B ultrasound once every 4 cycles of chemotherapy,except for patients with disease changes in time),PET-CT in the initial diagnosis and treatment,and long-term follow-up of patients' survival.PET-CT results in the middle of treatment were scored by Deauville scale,Lugano efficacy evaluation and prognosis evaluation were conducted.SPSS 20.0software was used for statistical analysis.X2 test was used to count the data,with P< 0.05 as the difference.According to Kaplan Meier method,draw whether to use PET-CT for treatment guidance,different stages,low-risk and high-risk groups of Deauville scale,change the survival curve after treatment plan when PET-CT is positive,and evaluate the prognosis of patients.To explore the guiding role of PETCT in the mid-term evaluation of treatment.To explore the guiding role of PET-CT in the mid-term evaluation of treatment.By calculating the positive predictive value of PET-CT positive patients at different time,and comparing them to find a more accurate time node for PET-CT mid-term efficacy evaluation results.Results:Among these 117 patients,16 were in stage I-II,15 in stage II,101 in stage IIIIV,and 65 in stage II zero point zero five The recurrence rate of stage I-II is less than that of stage III-IV.According to the IPI score,the patients were divided into low-risk and high-risk groups,30 in the low-risk group,27 in the two-year disease-free survival,87 in the middle and high-risk group,and 5 in the two-year disease-free survival.The difference was statistically significant after chi square test,indicating that the prognosis of low-risk patients was relatively good,and the possibility of progression and recurrence of middle and high-risk patients was relatively high.The LDH value of the patients was less than 215.0U/L There were 49 normal patients,38 of whom had no relapse or progress within 2 years 215.0U/L There were 68 cases of abnormal and 42 cases of PFS in 2 years.There were 36 patients who had PET-CT mid-term efficacy evaluation,and 81 patients who had PET-CT mid-term efficacy evaluation.The disease-free survival time of 117 patients was analyzed by Kaplan Meier method,and the survival function chart was drawn.Among the patients evaluated by PET-CT,36 had no disease progression,relapse or death in 2 years,and the other 6 had relapse,including 1 death.Of the remaining 81 patients who used CT to evaluate the mid-term efficacy,49 did not recur within 2 years.Of the other 32 cases,3 died.It can be seen from the survival analysis that PET-CT can be used to evaluate the mid-term curative effect,which is helpful to guide the patients to carry out the late treatment and improve the prognosis.The survival analysis was carried out for the patients who had two courses of treatment and four courses of mid-term efficacy evaluation.The survival curve of the patients who had two courses of treatment and four courses of mid-term efficacy evaluation indicated that the prognosis of PET-CT negative patients was better than that of positive patients.PETCT has a predictive effect on the prognosis of patients.The disease-free survival rate of the patients who were evaluated after two courses of treatment was about 73.7%The disease-free survival rate of the patients who were evaluated after 4 courses of treatment was about 88.2% ? Kaplan Meier survival analysis was carried out and the survival function diagram was drawn.It can be seen that the disease-free survival period of the patients who had the mid-term efficacy evaluation after four courses is longer than that of the patients who had two courses.It is suggested that the patients who found PET-CT positive in the early stage of four courses can change the treatment plan in time,the patients who had PET-CT negative can reduce the chemotherapy course in time and improve the prognosis of the patients.Among the12 PET-CT positive patients,7 were positive in the mid-term efficacy evaluation of PET-CT after the second course of treatment,1 was true positive in recurrence,and the positive predictive value was 0.28 ? After the fourth course of treatment,5patients were positive for PET-CT mid-term efficacy evaluation,of which 2 were true positive for recurrence,PPV= 0.4? The PPV of the fourth course was higher than that of the second course.This suggests that the mid-term efficacy evaluation of PETCT after the end of the fourth course is more accurate.Conclusion: The prognosis of DLBCL was affected by many factors.In this study,whether Ann Arbor III-IV and IPI score PET-CT were positive or not were independent risk factors for prognosis of DLBCL patients.Ann Arbor stage III-IV and IPI score are poor prognosis in high-risk patients,while PET-CT mid-term evaluation positive is the adverse factor of DLBCL prognosis.The time selection of PET-CT mid-term efficacy evaluation has an impact on the prognosis.After 4 courses of treatment,the midterm efficacy evaluation is more significant,which is conducive to early identification of high-risk patients.