诊断学理论与实践

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

• 论著 • 上一篇    下一篇

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. 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.开云网页登录 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.开云网页登录 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.开云网页登录 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 Xinyun2a, GUO Rui2a, YI Hongmei2b, XU Pengpeng2c, WU Zhifang1, LI Biao2a()   

  1. 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

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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），按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影像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 cm比33.82 cm，P=0.031），全身病灶数量更多（7个比4个，P=0.002）。IPI评分能识别出低风险的FL/DLBCL患者（IPI评分为0～1）（P=0.010），但无法明确中低危、中高危或高危（IPI评分为2分、3分和4~5 分）的患者（P=0.743）。Cox回归分析证实，Dmax>73.08 cm（HR=3.151，95%CI为1.253～7.922，P=0.015）和IPI 2~5分（HR=3.285，95%CI为1.208～8.932，P=0.020）均是FL/DLBCL患者PFS期的独立预后因素。据此建立列线图构建新的预测模型，其C指数为0.701，新模型区分低危、中危和高危的能力，明显优于IPI（P=0.052），似然比检验、Wald 检验和得分检验均提示有较显著的统计学意义（χ2分别为13.27、12.88、15.11，P值分别为0.001、0.002、<0.001）。新模型预测FL/DLBCL患者2年PFS率的ROC曲线下面积（AUC）值为0.770，高于IPI的AUC值0.702（P<0.05）；预测2年总体生存（OS）率的AUC值0.827也显著优于IPI的AUC值0.745（P<0.05）。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（>73.08 cm）和IPI（2~5分）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 differences in imaging features between FL/DLBCL and DLBCL, and to integrate baseline PET/CT characteristics with clinical parameters to improve the prognostic efficiency of the IPI 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 evaluated using the concordance index (C-index) and receiver operating characteristic (ROC) curves. Results Compared with DLBCL, FL/DLBCL patients had a greater maximum distance between two lesions (Dmax) on PET/CT images (55.07 cm vs.33.82 cm, P=0.031) and a greater number of total lesions throughout the body (7 vs. 4, P=0.002). The IPI score could identify FL/DLBCL patients with low risk (IPI score 0-1) (P=0.010), but failed to identify patients with intermediate-low risk, intermediate-high risk or high risk (IPI score 2, 3 and 4-5) (P=0.743). Cox regression analysis confirmed that Dmax > 73.08 cm (HR = 3.151, 95% CI 1.253-7.922, P = 0.015) and IPI score 2-5 (HR = 3.285, 95% CI 1.208-8.932, P=0.020) were independent risk factors for PFS in FL/DLBCL patients. On this basis, a nomogram was constructed to demonstrate that the new model's hazard discrimination capability (P<0.001) significantly outperformed the IPI (P=0.052),with a Cindex of 0.701. The likelihood ratio test, Wald test and score test all demonstrated highly significant statistical significance (χ2 values were 13.27, 12.88, and 15.11, respectively, and P values were 0.001, 0.002, and <0.001, respectively). The area under the ROC curve (AUC) value predicted by the new model for the 2-year PFS rate in FL/DLBCL patients was 0.770, which was higher than the AUC value of 0.702 for IPI; The AUC value of 0.827 for predicting 2-year overall survival (OS) rate was also significantly better than the AUC value of 0.745 for IPI (P<0.05). Conclusion FL/DLBCL exhibits more disseminated characteristics on PET/CT images compared to DLBCL. Additionally, Dmax is a highly promising parameter for prognostic evaluation in FL/DLBCL, and the nomogram constructed based on Dmax >73.08 cm and IPI score of 2 to 5 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

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