治疗前18F-FDG PET/CT显像对结外NK/T细胞淋巴瘤的预后判断价值

doi:10.16150/j.1671-2870.2021.06.004

摘要/Abstract

摘要：

目的: 评估治疗前¹⁸氟-氟代脱氧葡萄糖（¹⁸F-fluorodeoxyglucos,¹⁸F-FDG）正电子发射计算机体层显像（positron emission tomography and computed tomography,PET/CT）检查对结外自然杀伤细胞/T细胞淋巴瘤[extranodal natural killer （NK）/T-cell lymphoma,ENKTL]的预后判断价值。方法: 回顾分析60例新诊断为ENKTL并接受治疗前¹⁸F-FDG PET/CT检查的患者。所有患者均采用基于培门冬酶的治疗方案。PET/CT检查参数包括最大标准化摄取值（maximum standardized uptake value,SUVmax）、平均SUV（SUVmean）、代谢肿瘤体积（metabolic tumor volume,MTV）、总病灶糖酵解量（total lesion glycolysis,TLG）;临床资料包括Ann Arbor分期、鼻部淋巴瘤浸润范围、鼻外淋巴瘤浸润、淋巴结受累、骨髓受累和性别、年龄等。针对上述指标分别进行单因素生存分析,使用对数秩检验比较,筛选出预后相关因素。采用Cox比例风险模型进行多因素分析,评估影响2年总生存（overall survival, OS）期和无进展生存（progression-free survival, PFS）期的独立预后因素。结果: 单因素生存分析提示, MTV（P<0.001）、TLG（P<0.001）、Ann Arbor分期（P<0.001）、鼻外淋巴瘤浸润（P=0.006）、淋巴结受累（P=0.031）和PET/CT上的骨髓受累（P<0.001）能预测患者的2年OS期,而SUVmax（P=0.653）、SUVmean（P=0.446）和鼻部淋巴瘤浸润范围（P=0.308）则无预后预测价值;MTV（P=0.001）、TLG（P=0.009）、Ann Arbor分期（P<0.001）、鼻外淋巴瘤浸润（P<0.001）和PET/CT上的骨髓受累（P<0.001）能预测患者的2年PFS期,而SUVmax （P=0.274）、SUVmean（P=0.213）、鼻部淋巴瘤浸润范围（P=0.621）和淋巴结受累（P=0.069）无预后判断价值。多因素分析显示,PET/CT检查提示骨髓受累和Ann Arbor分期均是患者OS期（分别为P=0.046 和P=0.019）和PFS期（分别为P=0.033和P=0.015）的重要独立预后因素。结论: ¹⁸F-FDG PET/CT检查结果提示骨髓受累及Ann Arbor分期是新诊断ENKTL患者OS期和PFS期的重要独立预后因素,可反映患者的预后。

关键词: 结外自然杀伤细胞/T细胞淋巴瘤, 预后, ¹⁸氟-氟代脱氧葡萄糖, 正电子发射计算机体层显像

Abstract:

Objective: To assess use of pretreatment ¹⁸F-FDG PET/CT in prognosis prediction of extranodal natural killer/T-cell lymphoma(ENKTL). Methods: Sixty consecutive patients with newly diagnosed ENKTL underwent pretreatment ¹⁸F-FDG PET/CT were included and all patients received a pegaspargase-based regime. The maximum standardized uptake value (SUVmax), mean SUV (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG) of the tumor, and clinical parameters including gender, age, ENKTL stage, nasal lymphoma infiltration range, extranasal lymphoma infiltration, lymph node involvement, bone marrow involvement. Survival curves and log-rank test were performed, and Cox proportional hazards model was used to assess the independent risk factors for overall survival(OS) and progression-free survival (PFS). Results: Survival analysis showed that MTV (P<0.001), TLG (P<0.001), PET/CT-based Ann Arbor stage (P<0.001), extranasal lymphoma infiltration (P=0.006), lymph node involvement (P=0.031), and bone marrow involvement on PET/CT (P<0.001) were predictive factors for 2-year OS, while SUVmax (P=0.653), SUVmean (P=0.446), and nasal lymphoma infiltration range (P=0.308) were not. SUVmax (P=0.274), SUVmean (P=0.213), nasal lymphoma infiltration range (P=0.621), and lymph node involvement (P=0.069) were not predictive factors for 2-year PFS,and MTV (P=0.001), TLG (P=0.009), PET/CT-based Ann Arbor stage(P<0.001), extranasal lymphoma infiltration (P<0.001), and bone marrow involvement on PET/CT (P<0.001) were predictive factors. Multivariate analysis showed PET/CT-based bone marrow involvement and Ann Arbor stage were independent prognostic factors for 2-year OS (P=0.046 and 0.019, respectively) and PFS (P=0.033 and 0.015), respectively. Conclusions: It reveals that ¹⁸F-FDG PET/CT-based bone marrow involvement and Ann Arbor stage are independent prognostic factors for both OS and PFS of newly diagnosed ENKTL.

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

中图分类号:

R733.4

冯国伟, 张晓娟, 郭睿, 关哲, 王越. 治疗前¹⁸F-FDG PET/CT显像对结外NK/T细胞淋巴瘤的预后判断价值[J]. 诊断学理论与实践, 2021, 20(06): 533-539.

FENG Guowei, ZHANG Xiaojuan, GUO Rui, GUAN Zhe, WANG Yue. The prognostic value of pretreatment ¹⁸F-FDG PET/CT in extranodal natural killer/T-cell lymphoma[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(06): 533-539.

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参考文献 35

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特征	计数（n=60）	百分比（%）
性别
男	42	70.0
女	18	30.0
年龄（岁）	46.8±15.3（14~77）
淋巴瘤鼻部及周围局部侵犯范围
无局部侵犯	9	15.0
侵犯范围小（1个区域）	24	40.0
侵犯范围大（>1个区域）	27	45.0
淋巴瘤鼻外侵犯
有	17	28.3
无	43	71.7
淋巴结侵犯
有	20	33.3
无	40	66.7
骨髓侵犯
有	4	6.7
无	56	93.3
Ann Arbor分期
Ⅰ	30	50.0
Ⅱ	16	26.7
Ⅲ	3	5.0
Ⅳ	11	18.3
B症状
有	24	40.0
无	36	60.0
东部肿瘤合作小组（ECOG）评分
低危（0~1分）	48	80.0
高危（2~5分）	12	20.0

参数	判断OS期		判断PFS期
参数	临界值	P值	临界值	P值
SUVmax	11.7^a)	0.774	11.7^a)	0.248
SUVmean	6.5^a)	0.712	6.5^a)	0.213
MTV（cm³）	26.5	0.001	25.3	0.007
TLG	130 428.1	0.001	95 095.3	0.035
LDH（IU/L）	168.0^a)	0.900	168.0^a)	0.217
Ki-67	60%^a)	0.921	60%^a)	0.935

危险因子	危险比（95%可信区间）	P值
MTV（>26.5/≤26.5）	2.268（0.446~11.538）	0.324
TLG（>130 428.1/≤130 428.1）	2.283（0.483~10.797）	0.298
骨髓浸润（有/无）	5.485（1.034~29.093）	0.046
淋巴瘤结外侵犯（有/无）	0.257（0.048~1.379）	0.113
Ann Arbor分期（Ⅰ~Ⅱ/Ⅲ~Ⅳ）	7.883（1.399~44.432）	0.019
淋巴结侵犯（有/无）	2.220（0.647~7.613）	0.205
B症状（有/无）	1.039（0.268~4.030）	0.956

危险因子	危险比（95%可信区间）	P值
MTV（>25.3/≤25.3）	2.623（0.546~12.600）	0.229
TLG（>95 095.3/≤95 095.3）	1.864（0.346~10.390）	0.468
骨髓浸润（有/无）	6.302（1.163~34.144）	0.033
淋巴瘤结外侵犯（有/无）	0.170（0.023~1.263）	0.083
Ann Arbor分期（Ⅰ~Ⅱ/Ⅲ~Ⅳ）	9.968（1.563~63.578）	0.015
ECOG评分（0~1分/2~5分）	1.501（0.346~6.509）	0.588

治疗前¹⁸F-FDG PET/CT显像对结外NK/T细胞淋巴瘤的预后判断价值

The prognostic value of pretreatment ¹⁸F-FDG PET/CT in extranodal natural killer/T-cell lymphoma

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