PURPOSE The aim of this study was to determine a better criterion for end-of-treatment PET (EoT-PET) assessment and prognostic evaluation of patients with diffuse large B cell lymphoma (DLBCL). METHOD EoT-PET scans were assessed using the visual Deauville 5-point scale (5PS) and LLR, the maximum standard uptake value ratio between the lesion and the liver. The cutoff value of LLR was obtained by receiver operator characteristic curve analysis. Patient outcomes were compared using Kaplan-Meier survival analysis. Prognostic indexes of different criteria were compared. Multivariate Cox regression analysis was performed to evaluate the prognostic factors. RESULTS Four hundred forty-nine newly diagnosed DLBCL patients who received rituximab-based immunochemotherapy were included, and the median follow-up duration was 41.4 months. Patients with Deauville score (DS) 4 displayed significantly longer PFS and OS compared with patients with DS 5 (both p < 0.001), and they had significantly shorter PFS (p < 0.01) but similar OS (p = 0.057) compared with patients with DS 1-3. The differences in PFS and OS between groups were all significant whether positive EoT-PET was defined as DS 4-5 or DS 5 (all p < 0.001). The optimal cutoff of LLR was 1.83, and both PFS and OS were significantly different between EoT-PET-positive and EoT-PET-negative patients as defined by the cutoff (both p < 0.001). LLR-based criterion displayed higher specificity, positive predictive value, and accuracy than 5PS-based criterion in the prediction of disease progression and death events. In the multivariate analysis, positive EoT-PET (as defined by LLR) was related to unfavorable PFS and OS (both p < 0.001). Additional treatment was not correlated with outcomes of EoT-PET-negative patients either defined by LLR or 5PS or EoT-PET-positive patients classified by 5PS, but it was the only beneficial factor for OS (p < 0.05) in EoT-PET-positive patients with LLR ≥ 1.83. CONCLUSION The optimal cutoff of LLR may be superior to Deauville criteria in identifying low-risk DLBCL patients with negative EoT-PET after the first-line immunochemotherapy and sparing them the cost and toxicity of additional treatment.

中文翻译：

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弥漫性大 B 细胞淋巴瘤治疗末期 FDG-PET/CT 的预后价值：视觉 Deauville 标准与基于病灶与肝脏 SUVmax 比率的评估系统的比较。

目的 本研究的目的是为弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者的治疗结束 PET (EoT-PET) 评估和预后评估确定更好的标准。方法 EoT-PET 扫描使用视觉多维尔 5 点量表 (5PS) 和 LLR（病变与肝脏之间的最大标准摄取值比率）进行评估。通过接受者操作特征曲线分析获得LLR的截止值。使用 Kaplan-Meier 生存分析比较患者结局。比较不同标准的预后指标。进行多变量 Cox 回归分析以评估预后因素。结果纳入以利妥昔单抗为基础的免疫化疗新诊断DLBCL患者449例，中位随访时间为41.4个月。与 DS 5 的患者相比，Deauville 评分 (DS) 4 的患者的 PFS 和 OS 显着延长（均 p < 0.001），并且与 DS 5 的患者相比，他们的 PFS 显着缩短（p < 0.01）但 OS 相似（p = 0.057） DS 1-3。无论阳性 EoT-PET 定义为 DS 4-5 还是 DS 5，组间 PFS 和 OS 的差异均显着（均 p < 0.001）。LLR 的最佳截止值为 1.83，根据截止值定义，EoT-PET 阳性和 EoT-PET 阴性患者的 PFS 和 OS 均存在显着差异（均 p < 0.001）。基于 LLR 的标准在预测疾病进展和死亡事件方面显示出比基于 5PS 的标准更高的特异性、阳性预测值和准确性。在多元分析中，阳性 EoT-PET（由 LLR 定义）与不利的 PFS 和 OS 相关（均 p < 0.001）。额外治疗与由 LLR 或 5PS 定义的 EoT-PET 阴性患者或由 5PS 分类的 EoT-PET 阳性患者的结局无关，但它是 EoT-PET-中 OS 的唯一有益因素（p < 0.05） LLR ≥ 1.83 的阳性患者。结论 LLR 的最佳截断值可能优于 Deauville 标准，以识别在一线免疫化疗后 EoT-PET 阴性的低风险 DLBCL 患者，并为他们节省额外治疗的成本和毒性。05) 在 LLR ≥ 1.83 的 EoT-PET 阳性患者中。结论 LLR 的最佳截断值可能优于 Deauville 标准，以识别在一线免疫化疗后 EoT-PET 阴性的低风险 DLBCL 患者，并为他们节省额外治疗的成本和毒性。05) 在 LLR ≥ 1.83 的 EoT-PET 阳性患者中。结论 LLR 的最佳截断值可能优于 Deauville 标准，以识别在一线免疫化疗后 EoT-PET 阴性的低风险 DLBCL 患者，并为他们节省额外治疗的成本和毒性。