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

doi:10.16150/j.1671-2870.2022.06.07

Abstract

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

CLC Number:

R541.7

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.

Figures/Tables 9

References 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

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

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