论著

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

展开
  • 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

  网络出版日期: 2023-04-23

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

Expand
  • 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 date: 2022-06-24

  Online published: 2023-04-23

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。

本文引用格式

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 . DOI: 10.16150/j.1671-2870.2022.06.07

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.

参考文献

[1] Tse E, Kwong Y L. NK/T-cell lymphomas[J]. Best Pract Res Clin Haematol, 2019, 32(3):253-261.
[2] Wang H, Fu B B, Gale R P, et al. NK-/T-cell lymphomas[J]. Leukemia, 2021, 35(9):2460-2468.
[3] 李小秋, 李甘地, 高子芬, 等. 中国淋巴瘤亚型分布:国内多中心性病例10002例分析[J]. 诊断学理论与实践, 2012, 11(2):111-115.
[3] Li X Q, Li G D, Gao Z F, et al. Distribution pattern of lymphoma subtypes in China: A nationwide multicenter study of 10002 cases[J]. J Diagn Concepts Pract, 2012; 11:111-115.
[4] Moon S H, Cho S K, Kim W S, et al. The role of 18F-FDG PET/CT for initial staging of nasal type natural killer/T-cell lymphoma: a comparison with conventional staging methods[J]. J Nucl Med, 2013, 54(7):1039-1044.
[5] 冯国伟, 张晓娟, 郭睿, 等. 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(6):533-539.
[5] Feng G W, Zhang X J, Guo R, et al. The prognostic value of pretreatment 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma[J]. J Diagn Concepts Pract, 2021, 20(6):533-539.
[6] 汤泊, 周锦, 郭喆, 等. 治疗前18F-FDG PET/CT显像代谢参数判断早期结外自然杀伤/T细胞淋巴瘤的预后价值[J]. 中华核医学与分子影像杂志, 2019, 39(12):732-738.
[6] Tang B, Zhou J, Guo Z, et al. Prognostic value of pretreatment 18F-FDG PET/CT imaging metabolic parameters in patients with early-stage extranodal natural killer/T cell lymphoma[J]. Chin J Nucl Med Mol Imaging, 2019, 39(12):732-738.
[7] Zhou X, Lu K, Geng L, et al. Utility of PET/CT in the diagnosis and staging of extranodal natural killer/T-cell lymphoma: a systematic review and meta-analysis[J]. Medicine (Baltimore), 2014, 93(28):e258.
[8] Khong P L, Huang B, Lee E Y, et al. Midtreatment 18F-FDG PET/CT Scan for Early Response Assessment of SMILE Therapy in Natural Killer/T-Cell Lymphoma: A Prospective Study from a Single Center[J]. J Nucl Med, 2014, 55(6):911-916.
[9] Guo R, Xu P, Xu H, et al. The predictive value of pre-treatment 18F-FDG PET/CT on treatment outcome in early-stage extranodal natural killer/T-cell lymphoma[J]. Leuk Lymphoma, 2020, 61(11):2659-2664.
[10] Suh C, Kang Y K, Roh J L, et al. Prognostic value of tumor 18F-FDG uptake in patients with untreated extranodal natural killer/T-cell lymphomas of the head and neck[J]. J Nucl Med, 2008, 49(11):1783-1789.
[11] Bai B, Huang H Q, Cai Q C, et al. Predictive value of pretreatment positron emission tomography/computed tomography in patients with newly diagnosed extranodal natural killer/T-cell lymphoma[J]. Med Oncol, 2013, 30(1):339.
[12] Chang Y, Fu X, Sun Z, et al. Utility of baseline, interim and end-of-treatment 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma patients treated with L-asparaginase/pegaspargase[J]. Sci Rep, 2017, 7:41057.
[13] Xu P P, Xiong J, Cheng S, et al. A Phase Ⅱ Study of Methotrexate, Etoposide, Dexamethasone and Pegaspargase Sandwiched with Radiotherapy in the Treatment of Newly Diagnosed, Stage IE to IIE Extranodal Natural-Killer/T-Cell Lymphoma, Nasal-Type[J]. EBioMedicine, 2017, 25:41-49.
[14] Carbone P P, Kaplan H S, Musshoff K, et al. Report of the Committee on Hodgkin’s Disease Staging Classification[J]. Cancer Res, 1971, 31(11):1860-1861.
[15] Kim S J, Yoon D H, Jaccard A, et al. A prognostic index for natural killer cell lymphoma after non-anthracycline-based treatment: a multicentre, retrospective analysis[J]. Lancet Oncol, 2016, 17(3):389-400.
[16] Meignan M, Gallamini A, Meignan M, et al. Report on the first international workshop on interim-PET-scan in lymphoma[J]. Leuk Lymphoma, 2009, 50(8):1257-1260.
[17] 中华医学会核医学分会. 淋巴瘤18F-FDG PET/CT及PET/MR显像临床应用指南(2021版)[J]. 中华核医学与分子影像杂志, 2021, 41(3):161-169.
[17] Chinese Society of Nuclear Medicine. Clinical practice guideline of 18F-FDG PET/CT and PET/MR in lymphoma(2021 edition)[J]. Chin J Nucl Med Mol Imaging, 2021, 41(3):161-169.
[18] 彭攀, 吴宁, 陶秀丽, 等. 18F-脱氧葡萄糖正电子发射计算机断层扫描对结外NK/T细胞淋巴瘤的疗前评估价值[J]. 中华肿瘤杂志, 2022, 44(4):370-376.
[18] Peng P, Wu N, Tao X L, et al. Pretreatment evaluation of 18F-FDG PET-CT in extranodal NK/T-cell lymphoma[J]. Chin J Oncol, 2022, 44(4):370-376.
[19] Ding H, Chang J, Liu L G, et al. High-dose methotrexate, etoposide, dexamethasone and pegaspargase (MEDA) combination chemotherapy is effective for advanced and relapsed/refractory extranodal natural killer/T cell lymphoma: a retrospective study[J]. Int J Hematol, 2015, 102(2):181-187.
[20] Liang R, Gao G X, Chen J P, et al. A phase 2 study of methotrexate, etoposide, dexamethasone, and pegaspargase chemotherapy for newly diagnosed, relapsed, or refractory extranodal natural killer/T-cell lymphoma, nasal type: a multicenter trial in Northwest China[J]. Hematol Oncol, 2017, 35(4):619-629.
[21] Sch?der H, Noy A, G?nen M, et al. Intensity of (18)fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin’s lymphoma[J]. J Clin Oncol, 2005, 23(21):4643-4651.
[22] Jiang C, Su M, Kosik R O, et al. The Deauville 5-point scale improves the prognostic value of interim FDG PET/CT in extranodal natural killer/T-cell lymphoma[J]. Clin Nucl Med, 2015, 40(10):767-773.
[23] Li Y X, Fang H, Liu Q F, et al. Clinical features and treatment outcome of nasal-type NK/T-cell lymphoma of Waldeyer ring[J]. Blood, 2008, 112(8):3057-3064.
[24] Jiang C, Zhang X, Jiang M, et al. Assessment of the prognostic capacity of pretreatment, interim, and post-therapy (18)F-FDG PET/CT in extranodal natural killer/T-cell lymphoma, nasal type[J]. Ann Nucl Med, 2015, 29:442-451.
[25] Naumann R, Vaic A, Beuthien-Baumann B, et al. Prognostic value of positron emission tomography in the evaluation of post-treatment residual mass in patients with Hodgkin’s disease and non-Hodgkin’s lymphoma[J]. Br J Haematol, 2001, 115(4):793-800.
[26] 中国抗癌协会肿瘤临床化疗专业委员会. 《中国淋巴瘤诊治专家共识(2016年版)》[M]. 北京: 人民卫生出版社, 2016.
[26] Cancer Clinical Chemotherapy Committee of China Anti-Cancer Association. Experts consensus on diagnosis and treatment of lymphoma in China (2016 version)[M]. Bejing: People’s Medical Publising House, 2016.
文章导航

/