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

doi:10.16150/j.1671-2870.2022.06.07

摘要/Abstract

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

中图分类号:

R541.7

王瑾, 郭睿, 李彪, 张晓哲. 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[J]. 诊断学理论与实践, 2022, 21(06): 702-709.

WANG Jin, GUO Rui, LI Biao, ZHANG Xiaozhe. Prognostic evaluation of extranodal natural killer/T-cell lymphoma, nasal type(ENKTL) with ¹⁸F-FDG PET/CT[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(06): 702-709.

图/表 9

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参考文献 26

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指标	病例数（n）	百分比（%）
性别
男	29	70.7
女	12	29.3
年龄（岁）
≤60	32	70.0
>60	9	30.0
Ann Arbor分期
Ⅰ	24	58.5
Ⅱ	12	29.3
Ⅲ	0	0
Ⅳ	5	12.2
肿瘤原发部位
鼻腔	34	82.9
其他部位	7	17.1
累及淋巴结
是	13	31.7
否	28	68.3
骨髓浸润
是	3	7.3
否	38	92.7
ENKTL预后指数（PINK）
低危（0分）	26	63.4
中危（1分）	10	24.4
高危（2~4分）	5	12.2

DS（分）	中期显像（n=30）	治疗结束后显像（n=35）
1	18（60.0）	22（62.9）
2	3（10.0）	4（11.4）
3	5（16.7）	4（11.4）
4	2（6.7）	1（2.9）
5	2（6.7）	4（11.4）

参数	OS的ROC曲线			PFS的ROC曲线
参数	AUC（95% CI）	P值	界值	AUC（95% CI）	P值	界值
中期SUVmax	0.785（0.506~1.000）	0.034	6.1	0.751（0.530~0.972）	0.030	3.25
中期ΔSUVmax	0.694（0.376~1.000）	0.147	41.65%	0.683（0.433~0.932）	0.254	41.65%
治疗结束后SUVmax	0.887（0.766~1.000）	0.023	3.45	0.655（0.415~0.895）	0.511	3.45
治疗结束后ΔSUVmax	0.830（0.671~0.989）	0.066	68.50%	0.681（0.463~0.898）	0.188	68.50%

参数	2年总生存率（%）	2年无进展生存率（%）
Ann Arbor 分期
Ⅰ~Ⅱ期	88.9±5.2	64.0±9.1
Ⅲ~Ⅳ期	40.0±21.9	40.0±21.9
中期DS
1~3	88.0±6.5	76.0±8.5
4~5	40.0±21.9	40.0±21.9
中期SUVmax
<6.1（OS），<3.25（PFS）	92.3±5.2	86.7±8.8
≥6.1（OS），≥3.25（PFS）	0	53.3±12.9
中期ΔSUVmax
≥41.65%	91.3±5.9	82.6±7.9
<41.65%	42.9±18.7	28.6±17.1
治疗结束后DS
1~3	96.8±3.2	90.3±5.3
4~5	50.0±25.0	50.0±25.0
治疗结束后SUVmax
<3.45	100	91.3±5.9
≥3.45	75.0±12.5	75.0±12.5
治疗结束后ΔSUVmax
≥68.50%	100	94.1±5.7
<68.50%	83.3±8.8	77.8±9.8

参数	预测2年PFS的效能			预测2年OS的效能
参数	灵敏度（%）	特异度（%）	准确率（%）	灵敏度（%）	特异度（%）	准确率（%）
Ann Arbor 分期	80.0	69.4	70.7	80.0	86.1	75.6
中期DS	80.0	72	73.3	60.0	88.0	83.3
中期SUVmax	80.0	68.4	73.3	66.7	100	93.3
中期ΔSUVmax	45.5	89.5	73.3	66.7	87.5	83.3
治疗结束后DS	30.0	96.0	77.1	50.0	96.6	88.6
治疗结束后SUVmax	50.0	72.0	65.7	83.3	75.9	77.1
治疗结束后ΔSUVmax	60.0	52.0	54.3	83.3	44.8	51.4

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

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

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