诊断学理论与实践

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2021 , Vol. 20 >Issue 06: 533 - 539

DOI: https://doi.org/10.16150/j.1671-2870.2021.06.004

论著

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

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  • 1.上海交通大学医学院附属瑞金医院 a.核医学科,b.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
    2.山西省肿瘤医院 a.放射科,b.骨与软组织肿瘤科,山西 太原 030013

收稿日期: 2021-07-27

  网络出版日期: 2021-12-25

基金资助

上海市临床重点专科建设项目(shslczdzk03403)

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

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  • 1a. Department of Nuclear Medicine; 1b. Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Center, Shanghai 200025, China
    2a. Department of Radiology; 2b. Department of Bone and Tissue Tumor, Shanxi Provincial Cancer Hospital, Shanxi Taiyuan 030013, China

Received date: 2021-07-27

  Online published: 2021-12-25

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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

本文引用格式

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 . DOI: 10.16150/j.1671-2870.2021.06.004

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

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