诊断学理论与实践 ›› 2022, Vol. 21 ›› Issue (06): 702-709.doi: 10.16150/j.1671-2870.2022.06.07

• 论著 • 上一篇    下一篇

18F-FDG PET/CT显像动态评估自然杀伤/T细胞淋巴瘤(鼻型)治疗预后

王瑾1,2, 郭睿1,2, 李彪1,2, 张晓哲1,2()   

  1. 1.上海交通大学医学院附属瑞金医院核医学科,上海 200025
    2.分子影像精准诊疗省部共建协同创新中心瑞金中心,上海 200025
  • 收稿日期:2022-06-24 出版日期:2022-12-25 发布日期:2023-04-23
  • 通讯作者: 张晓哲 E-mail:zxz40909@rjh.com.cn
  • 基金资助:
    国家自然科学基金面上项目(82171975);上海市临床重点专科建设项目(shslczdzk03403)

Prognostic evaluation of extranodal natural killer/T-cell lymphoma, nasal type(ENKTL) with 18F-FDG PET/CT

WANG Jin1,2, GUO Rui1,2, LI Biao1,2, ZHANG Xiaozhe1,2()   

  1. 1. Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Ruijin Center, Shanghai 200025, China
  • Received:2022-06-24 Online:2022-12-25 Published:2023-04-23
  • Contact: ZHANG Xiaozhe E-mail:zxz40909@rjh.com.cn

摘要:

目的:观察18氟-氟代脱氧葡萄糖-正电子发射计算机体层显像(18F-fluorodeoxyglucose-positron emission computed tomography, 18F-FDG PET/CT)在评估鼻型结外自然杀伤/T细胞淋巴瘤(extranodal natural killer/T-cell lymphoma, nasal type,ENKTL)治疗预后的价值。方法:回顾性分析2014年10月至2021年6月间在本院就诊并经病理证实的41例新诊断ENKTL患者。所有患者均接受氨甲蝶呤、依托泊苷、地塞米松和培门冬酶(methotrexate, etoposide, dexamethasone and pegaspargase,MESA)方案治疗,记录ENKTL患者治疗前、治疗中期、治疗结束后的18F-FDG PET/CT显像结果,收集指标包括Deauville评分(Deauville score,DS)、最大标准化摄取值(maximal standardized uptake values,SUVmax)和SUVmax变化(ΔSUVmax)。采用单因素和多因素分析以评估这些指标对患者总生存期(overall survival,OS)和无进展生存期(progression-free survival,PFS)的预测价值。结果:本研究中位随访期为45个月(3~64个月),患者2年的总生存率和无进展生存率分别为83.0%±6.0%和76.0%±7.0%,5年的指标分别为61.0%±12.0%和53.0%±10.0%。单因素分析显示,治疗前Ann Arbor 分期(P=0.002),治疗中期DS(P=0.021)、SUVmax(P<0.001)、ΔSUVmax(P=0.007),和治疗结束后DS(P=0.001)、SUVmax (P=0.017)和ΔSUVmax(P=0.037)是治疗后总生存率的预后因素。治疗前Ann Arbor分期(P=0.006)、治疗中期DS(P=0.011)、SUVmax(P=0.015)、ΔSUVmax(P=0.011)和治疗结束后DS(P=0.018)是治疗后PFS的预后因素。多变量分析显示,治疗结束时的DS是无进展生存率的唯一独立预测因子(P=0.019),低DS与高DS的2年无进展生存率分别为90.3%±5.3%和50.0%±25.0%(P=0.018)。结果:ENKTL患者治疗结束时,18F-FDG PET/CT显像的DS是唯一独立预后因素,高DS提示2年无进展生存率低。

关键词: 结外自然杀伤细胞/T细胞淋巴瘤, 预后, 18F-FDGPET/CT

Abstract:

Objective: To evaluate the prognostic significance of 18F-fluorodeoxyglucose-positron emission computed tomography(18F-FDG PET/CT) detection in extranodal natural killer/T-cell lymphoma, nasal type(ENKTL). Methods: Forty-one pathologically confirmed ENKTL patients (from October, 2014 to June, 2021) received methotrexate, etoposide, dexamethasone and pegaspargase(MESA) regimen and pre-, mid-, and end-treatment 18F-FDG PET/CT scans were retrospectively analyzed. Deauville score (DS), maximal standardized uptake values (SUVmax) and the change of SUVmax (ΔSUVmax) were recorded for response assessment. Univariate and multivariate analysis were performed to assess the effects on overall survival (OS) and progression-free survival (PFS). Results: The median follow-up period was 45 months (range, 3-64 months). The rates of 2-year OS and PFS were 83.0%±6.0% and 76.0%±7.0%, respectively. The rates of 5-year OS and PFS were 61.0%±12.0% and 53.0%±10.0%,respectively. Univariate analysis revealed that pre-treatment Ann Arbor stage (P=0.002), mid-treatment DS (P=0.021), mid-SUVmax (P<0.001), mid-ΔSUVmax (P=0.007), end-treatment DS (P=0.001), end-SUVmax (P=0.017) and end-ΔSUVmax (P=0.037) were prognostic factors for OS. Pre-treatment Ann Arbor stage (P=0.006), mid-treatment DS (P=0.011), SUVmax (P=0.015), SUVmax (P=0.011) and end-treatment DS (P=0.018) were of prognostic significance for PFS. Multivariate analysis showed that DS at the end of treatment was the only significant independent predictor of PFS (P=0.019). The rates of 2-year PFS of low DS and high DS were 90.3%±5.3% and 50.0%±25.0%, respectively (P=0.018). Conclusions: For ENKTL, DS by 18F-fluoro at the end of treatment is the only significant independent predictor of PFS.

Key words: Extranodal natural killer/T-cell lymphoma, Prognosis, 18F-FDG PET/CT

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