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目的:探讨中期n 18F-脱氧葡萄糖(FDG)PET/CT评估结合B细胞淋巴瘤-2(Bcl-2)/MYC蛋白双表达在原发胃肠道弥漫性大B细胞淋巴瘤(PGI-DLBCL)危险度分层中的价值。n 方法:回顾性分析2012年6月至2019年5月间南京鼓楼医院46例PGI-DLBCL患者的资料，其中男21例、女25例，年龄20～83岁。利用免疫组织化学法分析所有患者Bcl-2及MYC蛋白表达。患者均行基线及治疗中期[2～4周期利妥昔单克隆抗体+环磷酰胺+多柔比星+长春新碱+泼尼松(R-CHOP)方案化疗]PET/CT评估。采用Deauville 5分法(DS)和最大标准摄取值(SUVn max)变化率(ΔSUVn max%)进行中期评估。采用Kaplan-Meier生存分析、单因素和多因素Cox比例风险回归模型对3年无进展生存(PFS)率及3年总生存(OS)率进行预后分析。n 结果:随访6～84个月，进展14例，死亡9例。患者PFS率为69.6%，OS率为80.4%。Bcl-2/MYC蛋白双表达、DS和ΔSUVn max%为PFS预测因子[风险比(n HR)值：3.280、5.120和9.167，均n P<0.05]，乳酸脱氢酶(LDH)水平、MYC蛋白表达、DS及ΔSUVn max%是OS的预测因子(n HR值：4.091、9.618、7.697和11.151，均n P<0.05)；多因素分析显示DS及ΔSUVn max%是PFS和OS的独立预测因子[n HR值：4.370～9.244，均n P<0.05]。预后再分层结果显示，DS阴性患者(n n＝33)中，双表达阳性者的PFS率及OS率均较阴性者低[PFS率：50.0%与88.9%；OS率：66.7%与96.3%; n χ2值：6.050和4.966，均n P<0.05]，而在ΔSUVn max%<90%患者(n n＝24)中，双表达阳性者仅3年PFS率较阴性患者低(12.5%与68.8%; n χ2＝6.649，n P＝0.01)。n 结论:DS和ΔSUVn max%是PGI-DLBCL治疗中期预后的独立预测因素，DS、ΔSUVn max%与双表达结合可更好地对患者进行危险度分层。n “,”Objective:To explore the potential value of interim n 18F-fluorodeoxyglucose (FDG) PET/CT combined with B-cell lymphoma-2 (Bcl-2)/MYC protein dual expression (DE) status in the prognostic stratification for patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL).n Methods:Forty-six patients (21 males, 25 females; age 20-83 years) with newly diagnosed PGI-DLBCL from June 2012 to May 2019 in Nanjing Drum Tower Hospital were enrolled in this retrospective study. Immunohistochemistry for Bcl-2 and MYC protein expression was performed. All patients underwent baseline and interim (after 2-4 cycles of cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (R-CHOP) regimen) n 18F-FDG PET/CT scans for assessment. Interim n 18F-FDG PET/CT results were determined based on Deauville 5-point scale (DS) and changing rate of maximum standardized uptake value (ΔSUVn max%) in n 18F-FDG PET/CT images. Kaplan-Meier survival analysis, Cox proportional hazards regression model (single factor, multiple factors analysis) were used to analyze the prognosis (3-year progression free survival (PFS) and overall survival (OS) rates).n Results:Patients were followed up for 6-84 months, and 14 showed disease progression and 9 died. The PFS rate and OS rate were 69.6% and 80.4%, respectively. DE, DS as well as ΔSUV n max% were significant predictors of PFS (hazard ratio (n HR) values: 3.280, 5.120, 9.167, all n P<0.05); lactate dehydrogenase (LDH), MYC protein expression, DS and ΔSUVn max% were significant predictors of OS (n HR values: 4.091, 9.618, 7.697, 11.151, all n P<0.05). Multivariate analysis revealed that DS and ΔSUVn max% were independent predictors of PFS and OS (n HR values: 4.370-9.244, all n P<0.05). In the DS negative (-) group, patients with DE positive (+ ) had lower PFS and OS rates than those with DE- (PFS rate: 50.0%n vs 88.9%; OS rate: 66.7% n vs 96.3%; n χ2 values: 6.050, 4.966, both n P<0.05). In ΔSUVn max%<90% group, patients with DE+ had lower PFS rate than those with DE- (12.5%n vs 68.8%; n χ2=6.649, n P=0.01).n Conclusions:Interim PET/CT analysis using DS and ΔSUV n max% is able to predict survival in PGI-DLBCL patients. The combination of DS, ΔSUV n max% and DE can risk-stratify PGI-DLBCL patient more effectively.n