| Objective To summarize the distribution of the pretreatment positron emission computed tomography(PET-CT)in patents with Non-Hodgkin's lymphoma(NHL)admitted in General Hospital Of Ningxia Medical University from 2012 to 2018 through case retrospective studies.To analysis the value of stage with PET-CT in NHL patients.To investigate the prognostic value and application of the maximum standard uptake value(SUVmax),metabolic tumor volume(MTV),total glycolysis of lesions(TLG)measured by pretreatment PET-CT in patents with NHL and the general features,clinical and pathological features,laboratory paraments,therapeutic regimen,status of survival and the first treatment in patents with NHL,especially in DLBCL.In order to provide theoretical reference of standardizing the clinical individual therapy,filling in the blanks of correlational research in hospital and predicting the prognosis of NHL,especially in DLBCL,so as to lay the foundation of promoting the standardization of diagnosis and treatment of NHL in the region.Methods Collecting 78 cases from October 31,2012 to January 1,2018 in General Hospital Of Ningxia Medical University who had diagnosed with NHL by histopathology after surgery or biopsy.All patients underwent PET-CT before treatment and hosted complete clinical data.Firstly,the stages of NHL patients were interpreted according to baseline enhanced CT examination,and then the stages were interpreted according to PET-CT examination.SUVmax,MTV and TLG values of lesions,which were delineated by software automatically,were calculated from PET-CT images with a threshold of standard uptake value(SUV),which equaled 2.5.The Spearman correlation analysis was used to perform the correlation of tumor related makers(SUVmax,MTV,TLG)of PET-CT and prognosis related factors{patients'general features(including age,gender),clinical features[including B symptoms,international prognostic index(IPI),Ann Arbor stage,starting position],laboratory paraments[including lactate dehydrogenase(LDH),?-2 microglobulin(?-2 MG),erythrocyte sedimentation rate(ESR)],pathological features[including histological type,tumor cell-derived,cell proliferation index(Ki-67)],treatment-related indicators[treated or not,different therapeutic opinions,application of targeted drugs or not,and the curative effect of the first treatment(complete response rates),etc.}.Secondly,with progression-free survival(PFS)as the positive event,the optimal cut-off values of SUVmax,MTV and TLG were obtained though the receiver operating characteristic(ROC)curve and area under the curve(AUC).Finally,the Kaplan-Meier method and Log-rank test were used to perform univariate survival analysis,while Cox proportional hazards model was done for multivariate respectively.Results 1.In 78 NHL cases,according to Deaville 5-point rating standard,all patients'Deaville scores were above 4,all of them were positive,and the positive rate of imaging was100%.And the baseline enhanced CT was performed according to Ann Arbor staging criteria:16 cases in stage 1,29 cases in stage 2,13 cases in stage 3 and 20 cases in stage 4.Then the clinical stages were adjusted by PET-CT examination,and there were 20 cases(25.6%)for all.After adjustment,the distribution of patients in each stage was as follows:9 cases in stage 1,26 cases in stage 2,15 cases in stage 3 and 28 cases in stage 4.2.In 47 DLBCL patients,the SUVmax was between 3.42~52.54.The median SUVmax was 13.94.MTV changed from 0.39 to 35.70cm~3,and the median is 39.62cm~3.TLG varied from 2.99 to 668.05g.The median is 39.62g.The areas under the ROC curve(AUC)of SUVmax,MTV,TLG were 0.505(95%CI=0.325~0.684,P=0.961),0.544(95%CI=0.358~0.730,P=0.652),0.575(95%CI=0.375~0.734,P=0.457).As for the above numbers were smaller,the median of SUVmax,MTV and TLG were 13.94,4.15cm~3,39.62g used as the cutoff lines,respectively.3.In 47 DLBCL cases,12 cases were recurrence or progressive,the median PFS was 24months,1-year PFS,2-year PFS,3-year PFS,4-year PFS and 5-year PFS were 87.2%,77.4%,64.7%,64.7%and 64.7%.And there were 5 patients dead,the median overall survival(OS)was 26 months,1-year OS,2-year OS,3-year OS,4-year OS and 5-year OS were 100%,94.8%,85.2%,74.5%and 74.5%.Kaplan-Meier method by single analysis showed:baseline stage,whether adjust clinical stage or not,IPI score,different treatment opinions,curative effect of the first treatment and targeted therapy were associated with the prognosis of DLBCL,presented significant correlation(P<0.05 for all),otherwise,SUVmax,MTV,TLG,level of LDH,?-2 MG,Ann arbor stage,gender,level of Ki-67,tumor cell-derived,B symptoms,starting position and adjusted clinical stage were not associated the prognosis.4.Multivariate analysis those single factors who may affect DLBCL by Cox survival model showed:clinical staging adjusted by PET-CT and different treatment opinions were independent prognostic factors of PFS in DLBCL patients.There was no independent prognostic factors of OS in DLBCL patients.Conclusion 1.Before treatment,25.6%(20/78)of the NHL patients were examined by PET-CT,and the clinical staging was up-regulated,but no down-regulated staging was found.2.For DLBCL patients,the prognostic value of SUVmax,MTV and TLG before treatment initiation are undetermined,and these indices cannot be applied to predict prognosis. |
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