| Objective PET/CT is a widely used imaging technique for evaluating the response and prognosis of lymphoma.IHPC and Deauville criteria are the visual method to assess response based on the PET/CT images.The current study aimed to compare the value of IHPC and Deauville criteria in the evaluation of response assement and prognosis in HL and NHL patients.And to further stratifiy the prognosis of 27 DLBCL patients by clinical and biological markers.Methods From January 28th 2010 to October 31st 2016,a total of 70（40 males,30 femals,median age:64 years old）HL and NHL patients with complete clinical data were retrospectively enrolled in this study,all patients performed18F-FDG PET/CT examination before and after chemotherapy at PET/CT Center of Tianjin Medical University General Hospital and finally pathologically diagnosed as lymphoma.There are 23 cases of HL and 47 cases of NHL,in NHL,there were 5 cases of follicular lymphoma,1 case of Burkitt lymphoma,2 cases of NK/T cell lymphoma and 1 case of mantle cell lymphoma.End of treatment FDG PET/CT images were interpreted with Deauville criteria and IHPC,according to the clinical records,imaging and follow-up results to determine which criteria best predicted the result after chemotherapy.Each patient was followed up for a minimum of 12 months,and the median follow-up was 48months.Univariate and multivariate Cox regression analysis were used to compare the prognostic value of IHPC and Deauville criteria.In order to increase the comparability of the two criteria,the results of curative effect evaluation were divided into positive group and negative group.Among them,IHPC positive group includes partial remission,stable disease,disease progression,negative group includes complete remission.The Deauville criteria positive group was 4,5 points,the negative group was 1 and 2,3 points.Collecting the data of blood routine and pathological report before treatment.All patients were grouped according to whether the patient had anemia and whether the histological subtype was GCB.Drawing Survival Curve by Kaplan-Meier survival analysis to analysis the prognostic value of hemoglobin levels and histological subtypes for27 DLBCL patients with complete response.Results After chemotherapy,IHPC evaluation was positive in 31 cases and negative in 39 cases,of which 39 cases were CR,9 cases were PR,9 cases were SD,and 13 cases were PD.Deauville criteria evaluation was positive in 23 cases and negative in 47 cases,of which 22 cases were 1 point,12 cases were 2 point,13 cases were 3 point,13 cases were 4 point and 10 cases were 5 point.The clinical and imaging results after treatment confirmed that 50 of 70 patients had complete response and 20 had no complete response.Comparison of IHPC and Deauville criteria:（1）Response assement:IHPC:Se was 95.0%,Sp was 77.5%,PPV was 61.3%,NPV was 97.4%,accuracy was 81.4%and the AUC was 0.818.Deauville criteria:Se was 85.0%,Sp was 88.0%,PPV was 73.9%,NPV was93.6%,accuracy was 87.1%,and the AUC was 0.931.The difference of AUC is significant（Z=2.082,P=0.0374）.（2）Prognosis assement:Univariate Cox regression analysis showed that sex,cilinical stage,IHPC and Deauville criteria were significant for the prognosis of patients with HL and NHL,however,only the IHPC and Deauville criteria are independent prognostic factors,HR of IHPC and Deauville criteria was 6.611（95%CI:1.845-23.694,P=0.004）,9.136（95%CI:2.858-29.198,P<0.001）,respectively.Among the 70 patients of malignant lymphoma,38 cases were diagnosed as DLBCL,of which 27 cases were evaluated as complete remission according to Deauville criteria after treatment.Hemoglobin levels were lower than 130 g/L（M）or 115 g/L（F）in 10 out of 27 DLBCL patients with complete response,and the histological subtype of 17 patients was GCB.The results of further prognostic analysis of 27 DLBCL patients:（1）There was no significant difference in log-rank test between anemia group and non-anemia group（x2=0.601,P=0.438）.The 2 year PFS rate in anemic group was 90.0%and that in non-anemia group was 88.2%,the difference was not statistically significant（x2=0.020,P=0.888）.The 3 year PFS rate in anemic group was 90.0%and that in non-anemia group was 88.2%,the difference was not statistically significant（x2=0.020,P=0.888）.（2）The difference of log-rank test between GCB and non-GCB patients was statistically significant（x2=9.954,P=0.02）,the prognosis of patients with GCB were better than that of non-GCB group.The 2 year PFS rate in GCB group was 100%and that in non-GCB group was 65.6%,the difference was statistically significant（x2=5.738,P=0.017）.The 3 year PFS rate in GCB group was 100%and that in non-GCB group was 65.6%,the difference was statistically significant（x2=5.738,P=0.017）.Conclusion（1）In the actual clinical working state,IHPC and Deauville both have the value to evaluate response assement and prognosis in HL and NHL patients,and the Deauville criteria outperformed IHPC to some extent.（2）There was no significant correlation between hemoglobin level and prognosis of DLBCL patients who achieved complete response after treatment.Histologic types can further stratify the prognosis of DLBCL patients with complete response after chemotherapy,and patients with non-GCB subtype usually have poor prognosis. |
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