滤泡合并弥漫大B细胞淋巴瘤的PET/CT特征及其联合IPI在预后评估中的价值

doi:10.16150/j.1671-2870.2025.02.009

诊断学理论与实践 ›› 2025, Vol. 24 ›› Issue (02): 178-186.doi: 10.16150/j.1671-2870.2025.02.009

滤泡合并弥漫大B细胞淋巴瘤的PET/CT特征及其联合IPI在预后评估中的价值

李卓含¹^,^2a, 黄新韵^2a, 郭睿^2a, 易红梅^2b, 许彭鹏^2c, 武志芳¹, 李彪^2a()

^1.山西医科大学第一医院核医学科，山西医科大学分子影像精准诊疗省部共建协同创新中心，山西太原 030001
^2a.上海交通大学医学院附属瑞金医院. 核医学科，医学基因组学国家重点实验室，上海血液学研究所，上海 200025
^2b.上海交通大学医学院附属瑞金医院病理科，医学基因组学国家重点实验室，上海血液学研究所，上海 200025
^2c.上海交通大学医学院附属瑞金医院　a. 核医学科；b病理科；c血液科，医学基因组学国家重点实验室，上海血液学研究所，上海 200025

收稿日期:2025-01-06 接受日期:2025-03-24 出版日期:2025-04-25 发布日期:2025-08-19
通讯作者: 李彪 E-mail：lb10363@rjh.com.cn
基金资助:
上海申康医院发展中心临床科技创新项目(SHDC22023201)

Prognostic value of PET/CT characteristics and combined IPI in follicular lymphoma and diffuse large B-cell lymphoma

LI Zhuohan¹^,^2a, HUANG Xinyun^2a, GUO Rui^2a, YI Hongmei^2b, XU Pengpeng^2c, WU Zhifang¹, LI Biao^2a()

^1.Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Collaborative Innovation Center for Molecular Imaging, Shanxi Medical University, Taiyuan 030001, China
^2a.Department of Nuclear Medicine, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
^2b.Department of Nuclear Medicine, Department of Pathology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
^2c.Department of Nuclear Medicine Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received:2025-01-06 Accepted:2025-03-24 Published:2025-04-25 Online:2025-08-19

摘要/Abstract

摘要：

目的国际预后指数（the international prognostic index， IPI）对合并滤泡性淋巴瘤成分的弥漫大B细胞淋巴瘤（follicular lymphoma and diffuse large B-cell lymphoma，FL/DLBCL）患者的危险区分效能有限，本研究旨在探索FL/DLBCL与DLBCL在影像学特征中的差异，并将PET/CT基线特征与临床参数融合，以优化IPI评价FL/DLBCL患者预后的效能。方法收集2015年1月至2022年1月在本院就诊并经病理证实的65例连续FL/DLBCL患者（随访时间2.4~113.0个月），1∶1匹配一组同期诊断为DLBCL的患者（随访时间2.9~91.6个月），比较2组患者PET/CT特征及生存期的差异。应用Cox回归分析筛选FL/DLBCL患者无进展生存（progression-free survival， PFS）期的独立预后因子，并纳入列线图。结合C指数（concordance index）和受试者操作特征（receiver operating characteristic， ROC）曲线评价模型的预测价值。结果相较于DLBCL，FL/DLBCL患者PET/CT图像中的2个病灶之间最大距离（the largest distance between two lesions， Dmax）更大（55.07比33.82，P=0.031），全身病灶数量更多（7个比4个，P=0.002）。IPI只能区分FL/DLBCL低危与非低危2个风险组（P=0.010），但无法识别出进展高风险患者（P=0.743）。将PET/CT图像特征与临床参数融合分析显示，Dmax（HR=3.151，95%CI为1.253～7.922，P=0.015）和IPI（HR=3.285，95%CI为1.208～8.932，P=0.020）是FL/DLBCL患者PFS期的独立预后因素，据此建立列线图，其C指数为0.701，3项全局检验（似然比检验、Wald检验和得分检验）均表现出高度统计学意义（χ²分别为13.27、12.88、15.11， P值分别为0.001、0.002、<0.001）。结论 FL/DLBCL在PET/CT图像上表现出比DLBCL更播散的特征；同时，Dmax是评估FL/DLBCL患者预后的十分有前景的参数，基于Dmax和IPI构建的列线图在预测FL/DLBCL生存期时表现出很好的区分效能和预测准确性。

关键词: 国际预后指数, PET/CT, 弥漫大B细胞淋巴瘤, 滤泡性淋巴瘤, 预后

Abstract:

Objective The international prognostic index (IPI) has limited ability to distinguish risk levels in patients with follicular lymphoma and diffuse large B-cell lymphoma (FL/DLBCL). This study aims to investigate the diffe-rences in imaging features between FL/DLBCL and DLBCL, and to integrate baseline PET/CT characteristics with clinical parameters to improve the ability of IPI to predict prognosis in FL/DLBCL patients. Methods A total of 65 consecutive patients with pathologically confirmed FL/DLBCL treated at our hospital between January 2015 and January 2022 were collected (follow-up duration: 2.4-113.0 months), and a 1∶1 matched group of patients diagnosed with DLBCL during the same period was selected (follow-up duration: 2.9-91.6 months). PET/CT features and survival differences between the two groups were compared. Cox regression analysis was used to identify independent prognostic factors for progression-free survival (PFS) in FL/DLBCL patients, which were incorporated into a nomogram. The predictive value of the model was evalua-ted using the concordance index (C-index) and receiver operating characteristic (ROC) curves. Results Compared with DLBCL, FL/DLBCL patients had a greater maxium distance between two lesions (Dmax) on PET/CT images (55.07 vs. 33.82, P=0.031) and a greater number of total lesions throughout the body (7 vs. 4, P=0.002). The IPI could only distinguish between low-risk and non-low-risk FL/DLBCL groups (P=0.010), but failed to identify patients at high risk of progression (P=0.743). Integrated analysis of PET/CT imaging features and clinical parameters showed that Dmax (HR=3.151, 95%CI: 1.253-7.922, P=0.015) and IPI (HR=3.285, 95%CI: 1.208-8.932, P=0.020) were independent prognostic factors for PFS in FL/DLBCL patients. On this basis, a nomogram was constructed, with a C-index of 0.701. All three global tests (likelihood ratio test, Wald test, and score test) showed high statistical significance (P<0.001). Conclusion FL/DLBCL exhibits more disseminated characteristics on PET/CT images compared to DLBCL. Additionally, Dmax is a highly promising para-meter for prognostic evaluation in FL/DLBCL, and the nomogram constructed based on Dmax and IPI demonstrates excellent discriminatory ability and predictive accuracy in predicting FL/DLBCL survival outcomes.

Key words: International prognostic index, PET/CT, Diffuse large B-cell lymphoma, Follicular lymphoma, Prognosis

中图分类号:

R814.4

李卓含, 黄新韵, 郭睿, 易红梅, 许彭鹏, 武志芳, 李彪. 滤泡合并弥漫大B细胞淋巴瘤的PET/CT特征及其联合IPI在预后评估中的价值[J]. 诊断学理论与实践, 2025, 24(02): 178-186.

LI Zhuohan, HUANG Xinyun, GUO Rui, YI Hongmei, XU Pengpeng, WU Zhifang, LI Biao. Prognostic value of PET/CT characteristics and combined IPI in follicular lymphoma and diffuse large B-cell lymphoma[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(02): 178-186.

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Item	FL/DLBCL (N=65)	DLBCL (N=65)	P value
Sex			0.599
Male	33 (50.8%)	30（46.2%）
Female	32 (49.2%)	35（53.8%）
Cell of Origin			0.159
Non-GCBs	31（47.7%）	39(60.0%)
GCBs	14（52.3%）	26(40.0%)
longest diameter of the largest node (cm)			0.303
≤6	47(72.3%)	52(80.0%)
>6	18(27.7%)	13(20.0%)
Double-expressor			0.493
Negative	40(66.7%)	47(72.3%)
Positive	20(33.3%)	18(27.7%)
Bone Marrow Involvement			0.042
Negative	52（80.0%）	60(92.3%)
Positive	13（20.0%）	5(7.7%)
*Age (years)			0.380
≤60	37（56.9%）	32（49.2%）
>60	28（43.1%）	33（50.8%）
*ECOG performance status			0.144
Negative	56（86.2%）	61(93.8%)
Positive	9（13.8%）	4(6.2%)
*Ann Arbor Stage			0.584
1-2	25（38.5%）	22(33.8%)
3-4	40（61.5%）	43(66.2%)
*Number of extra-nodal involvement			0.651
≤2	54（83.1%）	52(80.0%)
>2	11（16.9%）	13(20.0%)
*Serum lactate dehydrogenase levels			0.861
Normal	33（50.8%）	32(49.2%)
> 1×ULN	32（49.2%）	33(50.8%)
*IPI score			0.336
0-1	27（41.6%）	30（46.2%）
2	13（20.0%）	14（21.5%）
3	11（16.9%）	14（21.5%）
4-5	14（21.5%）	7（10.8%）

Item	FL/DLBCL(Median, IQR)	DLBCL(Median, IQR)	P value
SUVmax	21.78(14.87,33.42)	25.68(16.61,37.05)	0.458
MTVmax(mL)	83.13(13.80,378.25)	66.28(25.80,245.75)	0.891
TMTV(mL)	124.39(25.51,649.42)	84.01(40.57,365.78)	0.594
TLGmax	600.87(99.40,2546.89)	699.47(250.10,2420.73)	0.653
TLG	771.22(188.77,4527.02)	881.00(310.94,3735.38)	0.917
Dmax(cm)	55.07(8.37,69.53)	33.82(7.60,54.43)	0.031
Dmaxbulk(cm)	37.48(8.06,52.20)	27.99(7.60,48.09)	0.220
Number of lesions	7(3,21)	4(2,10.5)	0.002

Item	Univariable		Multivariable
Item	HR(95% CI)	P value	HR(95% CI)	P value
Sex	1.871(0.821,4.267)	0.136
Age(years)	1.173(0.533,2.582)	0.693
Cell of origin	1.361(0.611,3.032)	0.450
Double-expressor	0.473(0.158,1.415)	0.181
Extranodal involvement	3.653(1.544,8.641)	0.003
Bone marrow involvement	2.741(1.107,6.784)	0.029
Number of nodal sites	1.874(1.101,3.188)	0.021
Longest diameter of the largest node (cm)	1.655(0.730,3.754)	0.228
Ann Arbor stage	1.502(1.000,2.258)	0.050
B symptoms	1.186(0.463,3.035)	0.723
ECOG performance status	3.868(1.480,10.107)	0.006
IPI*	3.664(1.362,9.860)	0.010	3.285(1.208,8.932)	0.020
Serum lactate dehydrogenase levels	5.001(2.042,12.246)	0.000
β₂-microglobulin	1.826(0.743,4.486)	0.189
Hemoglobin	0.420(0.124,1.428)	0.165
Platelet count	1.817(0.755,4.374)	0.183
SUVmean	1.977(0.828,4.725)	0.125
SUVmax	1.898(0.820,4.393)	0.134
MTVmax	2.644(1.196,5.846)	0.016
TMTV	2.766(1.217,6.286)	0.015
TLGmax	2.949(1.229,7.079)	0.015
TLG	2.851(1.111,5.997)	0.027
Number of lesions	2.411(0.960,6.057)	0.061
Dmax	3.769(1.512,9.396)	0.004	3.151(1.253,7.922)	0.015
Dmaxbulk	2.964(0.881,9.967)	0.079
Spreadbulk	2.370(1.057,5.318)	0.036
Spreadpatient	6.319(0.852,46.834)	0.071

滤泡合并弥漫大B细胞淋巴瘤的PET/CT特征及其联合IPI在预后评估中的价值

Prognostic value of PET/CT characteristics and combined IPI in follicular lymphoma and diffuse large B-cell lymphoma

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