检索历史 清除

目的:对比弥漫大B细胞淋巴瘤(DLBCL)治疗结束时淋巴瘤疗效评价标准(RECIL)2017与Lugano标准对患者预后的判断。方法:回顾性分析2014年2月至2021年12月于河北医科大学第四医院诊治并于化疗结束时行PET/CT显像的DLBCL患者107例[男50例、女57例，年龄(49.3±17.4)岁]，采用RECIL2017与Lugano标准进行疗效评价，使用Kaplan-Meier生存分析评估无进展生存(PFS)和总生存(OS)。采用 Kappa检验分析2种标准评价疗效的一致性。采用ROC曲线(Delong检验)分析2种标准对PFS和OS的预测效能。 结果:患者中位随访时间为47.5(33.4，57.5)个月。Kaplan-Meier分析示，按Lugano标准评估的完全代谢缓解(CMR)、部分代谢缓解(PMR)、无代谢缓解(NMR)、疾病代谢进展(PMD)患者的5年PFS率[74.5%(35/47)、71.4%(15/21)、57.1%(12/21)、4/18]和OS率[89.4%(42/47)、81.0%(17/21)、61.9%(13/21)、7/18]差异均有统计学意义( χ2值：38.85、29.52，均 P<0.001)；RECIL2017评估的完全缓解(CR)、部分缓解(PR)、轻微缓解(MR)、疾病稳定(SD)、疾病进展(PD)组生存率差异同样有统计学意义[5年PFS率：76.9%(40/52)、8/12、6/11、6/12、30.0%(6/20)，5年OS率：90.4%(47/52)、8/12、6/11、9/12、45.0%(9/20); χ2值：29.05、23.63，均 P<0.001]。RECIL2017与Lugano标准在DLBCL患者化疗结束时的疗效评价具有较好的一致性[70.1%(75/107)； Kappa＝0.57， P<0.001]。对于PFS判断，Lugano标准的AUC为0.730(95% CI：0.625～0.834， P<0.001)，RECIL2017对应AUC为0.717(95% CI：0.612～0.822， P<0.001)；对于OS判断，Lugano标准的AUC为0.908(95% CI：0.845～0.970， P<0.001)，RECIL2017的AUC为0.880(95% CI：0.812～0.949， P<0.001)。Lugano标准评估PFS和OS的AUC略高，但差异无统计学意义( z值：0.44、1.09，均 P>0.05)。 结论:RECIL2017与Lugano标准均可以在DLBCL治疗结束时判断患者预后，且Lugano标准更准确。

Objective:To compare the predictive values of response evaluation criteria in lymphoma (RECIL)2017 and Lugano classification for the prognosis of patients with diffuse large B-cell lymphoma(DLBCL) at the end of treatment.Methods:A total of 107 patients (50 males, 57 females, age (49.3±17.4) years) with DLBCL who underwent PET/CT at the end of chemotherapy in the Fourth Hospital of Hebei Medical University between February 2014 and December 2021 were analyzed retrospectively. The RECIL2017 and Lugano classification were used to evaluate the response. Kaplan-Meier survival analysis was used to evaluate progression-free survival (PFS) and overall survival (OS). The Kappa test was used to evaluate the consistency of the two criteria after chemotherapy, and ROC curve (Delong test)was used to compare the predictive values of the two criteria for PFS and OS. Results:The median follow-up time was 47.5(33.4, 57.5) months. Kaplan-Meier analysis showed that the 5-year PFS rates (74.5%(35/47), 71.4%(15/21), 57.1%(12/21), 4/18; χ2=38.85, P<0.001) and OS rates (89.4%(42/47), 81.0%(17/21), 61.9%(13/21), 7/18; χ2=29.52, P<0.001) in complete metabolic response (CMR), partial metabolic response (PMR), no metabolic response (NMR) and progressive metabolic disease (PMD) groups evaluated by Lugano classification were statistically different, as well as those in complete response (CR), partial response (PR), minor response (MR), stable disease (SD) and progressive disease (PD) groups evaluated by the RECIL2017 (5-year PFS rates: 76.9%(40/52), 8/12, 6/11, 6/12, 30.0%(6/20), χ2=29.05, P<0.001; 5-year OS rates: 90.4%(47/52), 8/12, 6/11, 9/12, 45.0%(9/20), χ2=23.63, P<0.001). The RECIL2017 and Lugano classification had good consistency in the efficacy evaluation of DLBCL patients at the end of chemotherapy (70.1%(75/107); Kappa=0.57, P<0.001). The AUCs of Lugano classification for predicting PFS and OS were 0.730 (95% CI: 0.625-0.834, P<0.001) and 0.908 (95% CI: 0.845-0.970, P<0.001) respectively, and those of RECIL2017 were 0.717 (95% CI: 0.612-0.822, P<0.001) and 0.880 (95% CI: 0.812-0.949, P<0.001). The AUCs of the Lugano classification for PFS and OS were slightly higher than those of RECIL2017, without significant differences ( z values: 0.44, 1.09, both P>0.05) . Conclusion:Both RECIL2017 and Lugano classification can evaluate the prognosis of patients with DLBCL at the end of treatment, and Lugano classification is more accurate.