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

doi:10.16150/j.1671-2870.2021.06.004

Abstract

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

CLC Number:

R733.4

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.

Figures/Tables 7

References 35

[1]	Lee J, Suh C, Park YH, et al. Extranodal natural killer T-cell lymphoma, nasal-type: a prognostic model from a retrospective multicenter study[J]. J Clin Oncol, 2006, 24(4):612-618. doi: 10.1200/JCO.2005.04.1384 URL
[2]	Au WY, Ma SY, Chim CS, et al. Clinicopathologic features and treatment outcome of mature T-cell and natural killer-cell lymphomas diagnosed according to the World Health Organization classification scheme: a single center experience of 10 years[J]. Ann Oncol, 2005, 16(2):206-214. pmid: 15668271
[3]	Li CC, Tien HF, Tang JL, et al. Treatment outcome and pattern of failure in 77 patients with sinonasal natural killer/T-cell or T-cell lymphoma[J]. Cancer, 2004, 100(2):366-375. doi: 10.1002/cncr.11908 URL
[4]	姜璐, 赵维莅, 陈赛娟. 结外鼻型NK/T细胞淋巴瘤研究进展[J]. 诊断学理论与实践, 2012, 11(2):191-195.
[5]	Foss FM, Zinzani PL, Vose JM, et al. Peripheral T-cell lymphoma[J]. Blood, 2011, 117(25):6756-6767. doi: 10.1182/blood-2010-05-231548 URL
[6]	Chim CS, Ma SY, Au WY, et al. Primary nasal natural killer cell lymphoma: long-term treatment outcome and relationship with the International Prognostic Index[J]. Blood, 2004, 103(1):216-221. doi: 10.1182/blood-2003-05-1401 URL
[7]	Kim SJ, Yoon DH, 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. doi: 10.1016/S1470-2045(15)00533-1 URL
[8]	Cheson BD. Role of functional imaging in the management of lymphoma[J]. J Clin Oncol, 2011, 29(14):1844-1854. doi: 10.1200/JCO.2010.32.5225 pmid: 21482982
[9]	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]. 中核医学与分子影像杂志, 2021, 41(3):161-169.
[10]	Chan WK, Au WY, Wong CY, et al. Metabolic activity measured by F-18 FDG PET in natural killer-cell lymphoma compared to aggressive B- and T-cell lymphomas[J]. Clin Nucl Med, 2010, 35(8):571-575. doi: 10.1097/RLU.0b013e3181e4dcbf URL
[11]	Khong PL, Pang CB, Liang R, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in mature T-cell and natural killer cell malignancies[J]. Ann Hematol, 2008, 87(8):613-621. doi: 10.1007/s00277-008-0494-8 URL
[12]	Moon SH, Cho SK, Kim WS, 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 NuclMed, 2013, 54(7):1039-1044.
[13]	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. doi: 10.1097/MD.0000000000000258 URL
[14]	Fujiwara H, Maeda Y, Nawa Y, et al. The utility of positron emission tomography/computed tomography in the staging of extranodal natural killer/T-cell lymphoma[J]. Eur J Haematol, 2011, 87(2):123-129. doi: 10.1111/j.1600-0609.2011.01645.x pmid: 21557776
[15]	Wu HB, Wang QS, Wang MF, et al. Utility of ¹⁸F-FDG PET/CT for staging NK/T-cell lymphomas[J]. Nucl Med Commun, 2010, 31(3):195-200. doi: 10.1097/MNM.0b013e32833310fa URL
[16]	Karantanis D, Subramaniam RM, Peller PJ, et al. The value of [(18)F] fluorodeoxyglucose positron emission tomography/computed tomography in extranodal natural killer/T-cell lymphoma[J]. Clin Lymphoma Myeloma, 2008, 8(2):94-99. doi: 10.3816/CLM.2008.n.010 pmid: 18501102
[17]	Suh C, Kang YK, Roh JL, 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. doi: 10.2967/jnumed.108.053355 URL
[18]	沈文斌, 郭睿, 李彪. ¹⁸F-FDG PET/CT代谢参数在NK/T细胞淋巴瘤预后价值的评估[J]. 诊断学理论与实践, 2019, 18(3):349-352.
[19]	Kim SJ, Kim WS. Treatment of localized extranodal NK/T cell lymphoma, nasal type[J]. Int J Hematol, 2010, 92(5):690-696. doi: 10.1007/s12185-010-0720-8 URL
[20]	Ding H, Chang J, Liu LG, 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. doi: 10.1007/s12185-015-1809-x pmid: 25997870
[21]	Liang R, Gao GX, Chen JP, 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. doi: 10.1002/hon.2325 pmid: 27723108
[22]	Sabattini E, Bacci F, Sagramoso C, et al. WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview[J]. Pathologica, 2010, 102(3):83-87. pmid: 21171509
[23]	Carbone PP, Kaplan HS, Musshoff K, et al. Report of the Committee on Hodgkin′s Disease Staging Classification[J]. Cancer Res, 1971, 31(11):1860-1861. pmid: 5121694
[24]	Xu PP, 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. doi: 10.1016/j.ebiom.2017.10.011 URL
[25]	Schöder H, Noy A, Gönen M, et al. Intensity of ¹⁸fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin′s lymphoma[J]. J Clin Oncol, 2005, 23(21):4643-4651. pmid: 15837966
[26]	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(5):442-451. doi: 10.1007/s12149-015-0964-8 URL
[27]	Bai B, Huang HQ, Cai QC, 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. doi: 10.1007/s12032-012-0339-0 URL
[28]	张亚飞, 王珍, 林丽莉, 等. 治疗前¹⁸F-FDG PET/CT SUVmax对Ⅰ~Ⅱ期鼻型NK/T细胞淋巴瘤的预后判断价值[J]. 中华核医学与分子影像杂志, 2018, 38(9):602-604.
[29]	Khong PL, Huang B, Lee EY, 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. doi: 10.2967/jnumed.113.131946 URL
[30]	Xie M, Zhai W, Cheng S, et al. Predictive value of F-18 FDG PET/CT quantization parameters for progression-free survival in patients with diffuse large B-cell lymphoma[J]. Hematology, 2016, 21(2):99-105. doi: 10.1179/1607845415Y.0000000033 URL
[31]	Chang Y, Fu X, Sun Z, et al. Utility of baseline, interim and end-of-treatment(18)F-FDG PET/CT in extranodal natural killer/T-cell lymphoma patients treated with L-asparaginase/pegaspargase[J]. Sci Rep, 2017, 7:41057. doi: 10.1038/srep41057 pmid: 28117395
[32]	Li T, Zhang B, Ye Y, et al. Immunohistochemical and genetic analysis of Chinese nasal natural killer/T-cell lymphomas[J]. Hum Pathol, 2006, 37(1):54-60. doi: 10.1016/j.humpath.2005.09.020 URL
[33]	Kwong YL, Chan AC, Liang RH. Natural killer cell lymphoma/leukemia: pathology and treatment[J]. Hematol Oncol, 1997, 15(2):71-79. pmid: 9375032
[34]	Su YJ, Wang PN, Chang H, et al. Extranodal NK/T-cell lymphoma, nasal type: clinical features, outcome, and prognostic factors in 101 cases[J]. Eur J Haematol, 2018, 101(3):379-388. doi: 10.1111/ejh.13126 URL
[35]	Xu PP, Wang Y, Shen Y, et al. Prognostic factors of Chinese patients with T/NK-cell lymphoma: a single institution study of 170 patients[J]. Med Oncol, 2012, 29(3):2176-2182. doi: 10.1007/s12032-011-0011-0 URL

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

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

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