增强CT淋巴结边缘特征联合IPI对难治性弥漫大B细胞淋巴瘤的预测价值

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中图分类号：R733，R814.42 文献标志码：A DOI：10.11958/20252816

Abstract：ObjectiveTo explore the value lymph node margin features based on pre-treatment enhanced CT combined withtheinternationalprognostic index（IPI）inpredictingrefractorydiffuselarge B-cellymphoma （DLBCL）and to constructa nomogram prediction model.MethodsAtotal 98 patientswith newly diagnosed DLBCL were selected. Clinicaldata，pathological findingsandbaselineenhancedCTthepatients werecollcted.Thelymphnodemargn feature scoresinCTimages were independentlyevaluatedbytwo seniorradiologists，andthe highestscore was taken as the final lymph node margin feature score the patient.Allpatients received chemotherapy based on the R-CHOP regimen （6-8 cycles）.Patientswereclasified into thenon-refractorygroup（69cases）andtherefractory group（29cases）according tothe Lugano2O14responseevaluationcriteria.Logisticregressionanalysiswasusedtoidentifythefactorsinfluencing the development refractory DLBCL.A nomogram was constructed based onthe results the multivariate Logistic regression model.The receiver operating characteristic （ROC）curve was used to evaluate the discrimination ability the nomogram， and Hosmer-Lemeshow goodness--fittest wasused to assessitscalibration.ResultsCompared withthenon-refractory group，patients the refractory grouphad higher IPI scores，lymph node margin feature scores and serum PCTlevels （ P< 0.05）.Univariate binary Logisticregression analysis showed that lymph node margin featurescoresand IPIscores were factors influencing the development refractory DLBCL （P<0.01 ）.Multivariate binary Logistic regression analysis showed that increased lymph nodemargin feature scoresand IPI scoreswere risk factors for refractory DLBCL.A nomogram prediction model for thedevelopment refractoryDLBCL was establishedbasedon theresults Logisticregression analysis.TheROC curveanalysisshowed that theareaunder thecurve （AUC） the nomogrammodel for predicting refractory DLBCL was 0.840 （95% CI： 0.759 - 0.920），and Hosmer-Lemeshow χ2=5.794 P=0.670 ， indicating good fit. ConclusionTheenhanced CTlymph node margin feature scores combined with IPI scorescan efectively predict patients withrefractoryDLBCL.Theconstructednomogramprovidesapotentialpredictivetolfortheearlyidentificationhigh-risk patients and individualized treatment strategies in clinical practice.

Key Words：lymphoma，large B-cell，difuse; nomograms;contrast-enhanced CT;lymph node margin features; international prognostic index

弥漫大B细胞淋巴瘤（diffuselargeB-celllymphoma，DLBCL）是最常见的非霍奇金淋巴瘤亚型。（剩余10377字）