弥漫性大B细胞淋巴瘤基因变异特征与<sup>18</sup>F-FDG PET/CT SUV<sub>max</sub>的关系解析及其临床意义

田田; 陈晨; 魏然; 包龙龙; 顾丙新; 张群岭; 曹军宁; 于宝华; 李小秋; 周晓燕

doi:10.19401/j.cnki.1007-3639.2025.06.002

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弥漫性大B细胞淋巴瘤基因变异特征与¹⁸F-FDG PET/CT SUV_max的关系解析及其临床意义

论著 | 更新时间：2025-12-31

- 弥漫性大B细胞淋巴瘤基因变异特征与¹⁸F-FDG PET/CT SUV_max的关系解析及其临床意义
- The research on the association between genetic alterations of DLBCLs and ¹⁸F-FDG PET/CT SUV_max and their clinical significance
- 中国癌症杂志 2025年35卷第6期页码：531-542
- 作者机构：
  
  1. 复旦大学附属肿瘤医院病理科，复旦大学上海医学院肿瘤学系，复旦大学病理研究所，上海 200032
  2. 复旦大学附属肿瘤医院核医学科，复旦大学上海医学院肿瘤学系，上海 200032
  3. 复旦大学附属肿瘤医院肿瘤内科，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
  
  [ "田田（ORCID:0000-0003-3112-3735），博士，住院医师。" ]
  周晓燕（ORCID: 0000-0001-5999-7237），主任医师，教授。
- 基金信息：
  
  上海市协同创新集群(2019CXJQ03);上海市科学技术委员会“ 科技创新行动计划”医学创新研究专项(20Z11900300)
- DOI：10.19401/j.cnki.1007-3639.2025.06.002
  中图分类号： R733.4
- 收稿：2025-02-20，
  
  修回：2025-03-26，
  
  纸质出版：2025-06-30
- 稿件说明：
移动端阅览
田田, 陈晨, 魏然, 等. 弥漫性大B细胞淋巴瘤基因变异特征与¹⁸F-FDG PET/CT SUV_max的关系解析及其临床意义[J]. 中国癌症杂志, 2025,35(6):531-542.

Tian TIAN, Chen CHEN, Ran WEI, et al. The research on the association between genetic alterations of DLBCLs and ¹⁸F-FDG PET/CT SUV_max and their clinical significance[J]. China Oncology, 2025, 35(6): 531-542.
田田, 陈晨, 魏然, 等. 弥漫性大B细胞淋巴瘤基因变异特征与¹⁸F-FDG PET/CT SUV_max的关系解析及其临床意义[J]. 中国癌症杂志, 2025,35(6):531-542. DOI： 10.19401/j.cnki.1007-3639.2025.06.002.

Tian TIAN, Chen CHEN, Ran WEI, et al. The research on the association between genetic alterations of DLBCLs and ¹⁸F-FDG PET/CT SUV_max and their clinical significance[J]. China Oncology, 2025, 35(6): 531-542. DOI： 10.19401/j.cnki.1007-3639.2025.06.002.

摘要

背景与目的：

弥漫性大B细胞淋巴瘤（diffuse large B cell lymphoma，DLBCL）分子遗传学特征和患者治疗前

F-FDG PET/CT检查评估的SUV

max

值均与患者预后密切相关，但两者的关系及其与R-CHOP治疗方案治疗反应的相关性尚不清楚。本研究旨在分析DLBCL分子遗传学特征与治疗前经

F-FDG PET/CT检测的SUV

max

值的关系及其与临床病理学特征、R-CHOP治疗反应的相关性。

方法：

回顾性收集复旦大学附属肿瘤医院2022—2023年同时经淋巴瘤481基因DNA panel二代测序（next-generation sequencing，NGS）和治疗前经PET/CT检查的DLBCL患者225例，本研究通过复旦大学附属肿瘤医院医学伦理委员会的审查（伦理批号：050432-4-2307E）并获得患者知情同意；除基因突变特征外，同时收集荧光原位杂交法检测的

BCL2

、

BCL6

和

MYC

基因易位情况；另收集该组病例的临床病理学参数以及经R-CHOP治疗后的PET/CT检查结果。

结果：

总计191例DLBCL患者纳入最终分析，重要基因

MYD88

突变、

TP53

突变、

CDKN2A

拷贝数异常、

CD79B

突变发生率分别为24.6%、27.2%、32.5%和16.8%。治疗前SUV

max

值范围是5.10~63.10（24.44±10.70，中位22.80）。

MYD88

L265P

突变型DLBCL的治疗前SUV

max

值显著高于

MYD88

野生型DLBCL（

=0.039），SUV

max

值与DLBCL其他基因变异类型包括

TP53

突变、

CDKN2A/B

拷贝数减少、

CD79B

突变、

KMT2D

突变、

TNFAIP3

突变、

B2M

突变、

EZH2

突变、

BTG1/2

突变、

CREBBP

突变、

MYC

、

BCL2

、

BCL6

基因重排之间无显著的相关性。治疗前高SUV

max

值与高血清乳酸脱氢酶（lactate dehydrogenase，LDH）水平（

=0.012）及非生发中心（non-germinal center B-cell-like，non-GCB）亚型显著相关（

=0.040），但与R-CHOP治疗反应无显著的相关性（

=0.714）。DLBCL中

TP53

基因突变与R-CHOP治疗反应差显著相关（

=0.001），是R-CHOP治疗后非完全代谢缓解的独立预测因子。联合

TP53

基因突变、Ann Arbor分期、国际预后指数（International Prognostic Index，IPI）及血清LDH水平能够更好地预测患者对R-CHOP治疗的反应。

结论：

在DLBCL中，

MYD88

L265P

突变型患者具有较高的治疗前SUV

max

值。DLBCL治疗前SUV

max

值与R-CHOP治疗反应无关，而

TP53

基因突变与R-CHOP治疗反应差显著相关，并且是独立预测因子。

TP53

基因突变联合临床病理学参数可更好地预测R-CHOP治疗反应。关于各基因变异特征及SUV

max

值与患者预后的关系尚需作进一步随访研究。

Abstract

Background and purpose:

Next generation sequencing-identified genetic alterations of diffuse large B cell lymphoma (DLBCL) and baseline SUV

max

detected by

F-FDG PET/CT were correlated with patients’ prognosis. However

their relationship and the associations with R-CHOP response of DLBCL are still unclear. This study aimed to analyze the association bewteen genetic alterations and

F-FDG PET/CT SUV

max

and their correlations with clinicopathological characteristics and R-CHOP response of DLBCL.

Methods:

A total of 225 cases of primary DLBCL detected by next generation sequencing using 481 lymphoma gene panel and examined by

F-FDG PET/CT before treatment between 2022 and 2023 were collected. This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center (Ethical No.: 050432-4-2307E) and acquired the informed consent of the patients. The translocations of

BCL2

BCL6

and

MYC

were identified by fluorescence

in situ

hybridization. The clinicopathological characteristics and the PET/CT scan after R-CHOP chemotherapy were collected.

Results:

Finally

191 patients were enrolled in this study. The frequency of

MYD88

mutation

TP53

mutation

copy number variations of

CDKN2A/2B

CD79B

mutation in the 191 DLBCL patients were 24.6%

27.2%

32.5% and 16.8%

respectively. The range of baseline SUV

max

was 5.10-63.10 (24.44±10.70

median 22.80). The baseline SUV

max

MYD88

L265P

DLBCL was significantly higher than that of

MYD88

wild type (

=0.039). There were no significant associations of SUV

max

with other gene alterations including

TP53

mutation

CDKN2A/B

loss

CD79B

mutation

KMT2D

mutation

TNFAIP3

mutation

B2M

mutation

EZH2

mutation

BTG1/2

mutation

CREBBP

mutation

gene translocations of

MYC

BCL2

and

BCL6

. The higher SUV

max

before treatment was correlated with higher serum lactate dehydrogenase (LDH) level (

=0.012) and non-germinal center B-cell-like (non-GCB) DLBCL (

=0.040). However

there was no significant association of SUV

max

with R-CHOP response (

=0.714).

TP53

mutation was significantly associated with the poor response of R-CHOP (

=0.001) and was an independent predictor of non-complete metabolic response (non-CMR).

TP53

mutation combined with Ann Arbor stage

International Prognostic Index (IPI) score and serum LDH level could better predict R-CHOP response than each factor alone.

Conclusion:

MYD88

L265P

DLBCL had higher baseline

F-FDG PET/CT SUV

max

. The baseline SUV

max

was not associated with R-CHOP response. However

TP53

mutation was significantly correlated with poor response of R-CHOP in DLBCL patients.

TP53

mutation combined with clinicopathological characteristics could better predict R-CHOP response. The associations of gene alterations and SUV

max

with prognosis of DLBCL patients needed to be explored in the future.

关键词

Keywords

references

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弥漫性大B细胞淋巴瘤基因变异特征与18F-FDG PET/CT SUVmax的关系解析及其临床意义

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DOI：10.19401/j.cnki.1007-3639.2025.06.002

摘要

Abstract

关键词

Keywords

references

弥漫性大B细胞淋巴瘤基因变异特征与¹⁸F-FDG PET/CT SUV_max的关系解析及其临床意义

The research on the association between genetic alterations of DLBCLs and ¹⁸F-FDG PET/CT SUV_max and their clinical significance