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18F-FDG PET/CT代谢参数对接受CAR-T治疗的弥漫大B细胞淋巴瘤患者预后价值的队列研究
A cohort study of prognostic value of 18F-FDG PET/CT metabolic parameters in patients with diffuse large B-cell lymphoma treated with CAR-T
- 中国癌症杂志 2025年35卷第8期 页码：743-751
- 作者机构：
苏州大学附属第一医院核医学科，江苏 苏州 215006
- 作者简介：
[ "何超（ORCID: 0009-0004-0598-0869），硕士研究生在读。" ]
邓胜明（ORCID: 0000-0002-1450-7721），博士，主任医师。
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2025.08.002
中图分类号： R733.4收稿：2025-02-18，
修回：2025-06-17，
纸质出版：2025-08-30
- 稿件说明：
移动端阅览
何超, 周夜夜, 章斌, 等. 18F-FDG PET/CT代谢参数对接受CAR-T治疗的弥漫大B细胞淋巴瘤患者预后价值的队列研究[J]. 中国癌症杂志, 2025,35(8):743-751.
Chao HE, Yeye ZHOU, Bin ZHANG, et al. A cohort study of prognostic value of 18F-FDG PET/CT metabolic parameters in patients with diffuse large B-cell lymphoma treated with CAR-T[J]. China Oncology, 2025, 35(8): 743-751.
何超, 周夜夜, 章斌, 等. 18F-FDG PET/CT代谢参数对接受CAR-T治疗的弥漫大B细胞淋巴瘤患者预后价值的队列研究[J]. 中国癌症杂志, 2025,35(8):743-751. DOI： 10.19401/j.cnki.1007-3639.2025.08.002.
Chao HE, Yeye ZHOU, Bin ZHANG, et al. A cohort study of prognostic value of 18F-FDG PET/CT metabolic parameters in patients with diffuse large B-cell lymphoma treated with CAR-T[J]. China Oncology, 2025, 35(8): 743-751. DOI： 10.19401/j.cnki.1007-3639.2025.08.002.
摘要
背景与目的：
复发或难治性弥漫大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL）可采用嵌合抗原受体T细胞（chimeric antigen receptor T-cell，CAR-T）疗法进行治疗。基于影像学的特征有助于筛选可能对该免疫疗法产生临床应答的患者。本研究旨在建立一个基于
18
氟脱氧葡萄糖正电子发射断层显像（18-f1uoro-2-deoxy-D-glucose positronemision tomography-computed tomography，
18
F-FDG PET/CT）参数的模型，用于评估接受CAR-T疗法的复发或难治性DLBCL患者的无进展生存期（progre
ssion-free survival，PFS）和总生存期（overall survival，OS）。
方法：
回顾性分析2017年3月—2022年1月于苏州大学附属第一医院接受CAR-T治疗的DLBCL患者的临床和影像学资料。纳入标准：① 年龄≥18岁；② 病理学检查证实为复发或难治性DLBCL；③ CAR-T治疗前行
18
F-FDG PET/CT检查；④ 临床病理学数据完整；⑤ 患者必须有可测量的病灶。排除标准：① 患者的临床或影像学数据不完整；② 患有其他类型的恶性肿瘤；③ 在PET/CT扫描前1个月内接受过粒细胞集落刺激因子治疗。本研究通过苏州大学附属第一医院伦理委员会的审查（编号：2025256）。利用受试者工作特征曲线（receiver operating characteristic curve，ROC）确定最大标准摄取值（maximum standard uptake value，SUV
max
）、肿瘤代谢体积（metabolic tumour volume，MTV）和总糖酵解量（total lesion glycolysis，TLG）的最佳阈值，并将患者分为高风险组和低风险组。采用单因素和多因素Cox回归分析来确定潜在的影响预后的因素并构建预测模型，绘制列线图进行可视化分析。计算受试者工作特征曲线下面积评估各模型的性能。
结果：
本研究共纳入了61例（男性37例，女性24例，年龄26~75岁）在CAR-T输注前接受
18
F-FDG PET/CT检查的DLBCL患者。中位随访时间为14个月，36例（59.02%）患者出现疾病进展，25例（40.98%）患者死亡。多因素分析显示，细胞因子释放综合征（cytokine release syndrome，CRS）分级[风险比（HR）=3.671，
P
=0.003
]
和MTV（HR=0.171，
P
=0.004）是影响OS的独立预后因素；东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）评分（HR=2.411，
P
=0.019）、CRS分级（HR=2.499，
P
=0.027）和MTV（HR=0.338，
P
=0.007）是影响PFS的独立预后因素。综合模型（MTV、ECOG评分、CRS分级）在预测PFS和OS方面比临床模型（ECOG评分、CRS分级）、代谢参数模型（MTV）更佳。
结论：
18
F-FDG PET/CT代谢参数MTV联合传统的临床风险因素（ECOG评分、CRS分级）可识别出超高风险的DLBCL患者。
Abstract
Background and purpose:
Relapsed or refractory diffuse large B-cell lymphoma (DLBCL) can be treated with chimeric antigen receptor T-cell (CAR-T) therapy. Imaging-based biomarkers may help identify patients likely to achieve clinical response to this immunotherapy. In this study
an 18-f1uoro-2-deoxy-D-glucose positron emission tomography-computed tomography (
18
F-FDG PET/CT) based model was developed to assess the progression-free survival (PFS) and overall survival (OS) of patients with relapsed or refractory (R/R) DLBCL who received CAR-T therapy.
Methods:
We retrospectively analyzed clinical and imaging data from patients with DLBCL who underwent CAR-T therapy at the First Affi
liated Hospital of Soochow University between March 2017 and January 2022. Inclusion criteria: ① age ≥18 years old; ② pathologically confirmed R/R DLBCL; ③
18
F-FDG PET/CT performed before CAR-T cell therapy; ④ complete clinicopathologic data; ⑤ patients must have measurable lesions. Exclusion criteria: ① patients with incomplete clinical or imaging data; ② patients with other types of malignant tumors; ③ patients who have received granulocyte colony-stimulating factor treatment within 1 month prior to PET/CT scan. This study was reviewed by the Ethics Committee of the First Affiliated Hospital of Soochow University (ID: 2025256). Receiver operating characteristic (ROC) curves were used to determine the optimal thresholds for maximum standardized uptake value (SUV
max
)
tumor metabolic volume (MTV)
and total glycolysis (TLG)
and the patients were classified into high-risk and low-risk groups. Univariate and multivariate Cox regression analyses were used to identify potential prognostic factors and construct predictive models
which were visualized by drawing nomogram. Area under the ROC curve was used to assess the performance of each model.
Results:
A total of 61 patients (37 male patients and 24 female patients
aged 26-75 years) with DLBCL who underwent
18
F-FDG PET/CT prior to CAR-T infusion were included. The median follow-up was 14 months; 36 patients (59.02%) had disease progression and 25 patients (40.98%) died. Multivariate analysis showed that grade of cytokine release syndrome (CRS) [Hazard ratio (HR)=3.671;
P
=0.003
]
and MTV (HR=0.171
P
=0.004) were independent prognostic factors for OS; Eastern Cooperative Oncology Group (ECOG) score (HR=2.411
P
=0.019)
grade of CRS (HR=2.499;
P
=0.027)
and MTV (HR=0.338
P
=0.007) were independent prognostic factors for PFS. The combined model (MTV
ECOG score
grade of CRS) was better than the clinical model (ECOG score
grade of CRS)
an
d metabolic parameter model (MTV) in predicting PFS and OS.
Conclusion:
18
F-FDG PET/CT metabolic parameter MTV in combination with traditional clinical risk factors (ECOG score
Grade of CRS) could identify patients with ultra-high risk of DLBCL.
关键词
Keywords
references
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