本文于2026年3月发表于Journal of Nuclear Medicine and Molecular Imaging杂志。
文章链接(Article Link)：https://mednexus.org/doi/epdf/10.65457/JNMMI-2026-0002
引用本文：Liu F, Gu B, Xing Z, Li J, Zhang Q, Song S, Liu X. Mortalin and metabolic tumor volume as prognostic factors in diffuse large B-cell lymphoma treated with rituximab-based immunochemotherapy. J Nucl Med Mol Imaging 2026;2(1):9–21. doi: 10.65457/JNMMI-2026-0002
How to cite this article: Liu F, Gu B, Xing Z, Li J, Zhang Q, Song S, Liu X. Mortalin and metabolic tumor volume as prognostic factors in diffuse large B-cell lymphoma treated with rituximab-based immunochemotherapy. J Nucl Med Mol Imaging 2026;2(1):9–21. doi: 10.65457/JNMMI-2026-0002
既往研究发现，弥漫大B细胞淋巴瘤（DLBCL）患者基线的mortalin表达可能与R-CHOP标准方案治疗耐药及患者生存率降低相关。本文旨在进一步探究正电子发射断层扫描/计算机断层扫描（PET/CT）代谢参数和mortalin分子对DLBCL患者的预后预测价值，为该疾病的预后提出一种分子与影像学联合评估新指标。
该研究回顾性纳入了复旦大学附属肿瘤医院83例接受R-CHOP方案治疗的初诊DLBCL患者临床资料，记录基线PET/CT的各项代谢参数，包括SUVmax、SUVmean、代谢肿瘤体积（MTV）、总病灶糖酵解值（TLG）、异质性指数(HI= SUVmax/SUVmean)和病灶最大距离（Dmax），同时所有患者均进行mortalin分子检测。通过ROC曲线分析、单因素和多因素Cox回归分析，筛选影响DLBCL患者生存的独立预测指标，并基于筛选出的指标构建列线图预测模型，同时对该模型进行了验证。
This study retrospectively analyzed 83 cases to explore the prognostic value of baseline mortalinexpression and PET/CT-derived metabolic tumor volume (MTV) in diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP.
单因素分析显示，Ann Arbor分期、mortalin表达水平、Dmax、MTV、TLG与患者无进展生存期（PFS）显著相关；因MTV与TLG存在多重共线性，多因素分析仅保留MTV，结果证实mortalin表达阳性和 MTV大于166.28mL是影响患者PFS的独立危险因素。
Univariate and multivariate Cox proportional hazards regression analyses identified positive mortalinexpression and elevated MTV (cutoff value: 166.28 mL) as independent risk factors for inferior progression-free survival (PFS) in DLBCL patients undergoing R-CHOP therapy.
基于mortalin和MTV构建的3年、5年PFS列线图模型，C指数达0.902，校准曲线显示预测值与实际值一致性良好，Kaplan-Meier生存曲线证实该模型可将患者分为低、中、高风险组，且各组预后差异具有显著性意义。
A nomogram predictive model constructed by integrating mortalinand MTV exhibited high predictive accuracy for 3- and 5-year PFS, with a concordance index (C-index) of 0.902, and enabled effective risk stratification of the study population.
既往研究发现mortalin分子通过调控钙信号通路易引发利妥昔单抗耐药，PET/CT显像的高代谢参数反映了肿瘤负荷较高，二者或协同共同推动了 DLBCL 肿瘤耐药。
Mechanistically, mortalin is postulated to mediate rituximab resistance via the regulation of Ca²⁺signaling pathways, while elevated MTV reflects an increased tumor metabolic burden; these two factors may act synergistically to drive tumor resistance and poor clinical outcomes.
研究指出，基线PET/CT的MTV和mortalin表达可作为R-CHOP治疗DLBCL患者PFS的独立预测指标，mortalin有望纳入常规病理检查。但该研究样本量较小、且未深入探究mortalin表达与PET/CT参数之间的潜在关系，结论仍需大样本、前瞻性研究进一步验证。
This study confirms baseline mortalinexpression and MTV as reliable PFS predictors for R-CHOP-treated DLBCL patients and proposes mortalinas a candidate index for incorporation into routine pathological examinations.
该研究为DLBCL 患者的预后分层和个体化治疗提供了新的思路，也为未来靶向 mortalin的分子成像与治疗奠定了基础。
Furthermore, it provides a novel tool to optimize prognostic stratification and guide the formulation of personalized treatment strategies for DLBCL, though the findings warrant further verification in large-scale cohort studies.
基于（A）mortalin和MTV构建的DLBCL患者3年、5年无进展生存期列线图，其综合评分可评估其3年、5年无进展生存期的发生概率。（B, C）校准曲线显示预测值与实际值一致性良好。
(A) Nomogram for 3-year and 5-year PFS based on mortalinand MTV. For each patient, the parameters of mortalinand MTV are determinedon a scoring scale, and the total score determines the 3-year and 5-year PFS probability for each patient. Calibration curves for predicting 3-year (B)and 5-year (C) PFS in DLBCLpatients. The x-axis represents the nomogram-predicted 3-year and 5-year PFS probability, and the y-axis represents theobserved 3-year and 5-year PFS probability. The gray line represents perfect calibration.
DLBCL患者基于mortalin（A）、MTV（B）及列线图分层不同风险（C）的无进展生存期 Kaplan-Meier 生存曲线。
Kaplan-Meier survival curves for PFS in DLBCL patients with mortalin (A), MTV (B), and different risks stratified by the nomogram (C).
作者团队
复旦大学附属肿瘤医院核医学科是上海分子影像探针工程技术研究中心，上海市科委新型放射性药物研发和应用评价技术平台。拥有放射性药品使用许可证IV类证书，科室已临床转化30多种新型分子影像探针。多种分子影像探针临床转化，在肿瘤精准诊断、分期、疗效评估和活体内靶点表达的评估方面发挥着重要作用，已成为复旦肿瘤的特色品牌之一。近年来，科室人才队伍建设日益提升，一批获得上海市领军人才、上海市优秀技术带头人、上海市青年拔尖人才、上海市「浦江人才计划」、上海市「医苑新星」、上海市「扬帆计划」及「雏鹰计划」等中青年医学人才脱颖而出。近年来科室获得国家级课题24项，多项研究成果发表于 JCI、Advanced Science、JNM、EJNMMI、 Theranostics、Clinical Cancer Research、 ACS Nano等国际权威期刊，申请专利20项，成功商业转化专利5项。科室的学科地位与学术声誉不断提升。
第一作者刘菲
通讯作者刘晓晟
