汤泊; 周锦; 郭喆; 李天女; 丁重阳

doi:10.3760/cma.j.issn.2095-2848.2019.12.006

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• 临床研究 •

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

中华核医学与分子影像杂志, 2019,39(12) : 732-738. DOI: 10.3760/cma.j.issn.2095-2848.2019.12.006

摘要

目的

探讨治疗前¹⁸F-脱氧葡萄糖(¹⁸F-FDG)PET/CT显像代谢参数对Ⅰ～Ⅱ期结外自然杀伤/T细胞淋巴瘤(ENKTL)的预后价值。

方法

回顾性分析2010年8月至2018年4月间南京医科大学第一附属医院67例Ⅰ～Ⅱ期ENKTL患者(男47例、女20例，中位年龄57岁)的临床资料及治疗前¹⁸F-FDG PET/CT显像资料。以最大标准摄取值(SUV_max)的40%作为阈值，获得全身肿瘤的SUV_max、代谢体积(MTV)和病灶糖酵解总量(TLG)，采用受试者工作特征曲线(ROC)分析判断三者预测无进展生存(PFS)和总生存(OS)的最佳阈值。采用Kaplan-Meier法、log-rank检验及Cox比例风险回归模型分析数据。

结果

67例ENKTL患者的SUV_max、MTV及TLG分别为12.32(8.65, 16.96)、13.13(7.37, 22.74) ml和92.17(46.54, 198.46)。ROC曲线分析显示，三者判断PFS的阈值分别为13.09、18.05 ml和152.81。单因素分析中，B症状、乳酸脱氢酶(LDH)、β₂微球蛋白、美国东部肿瘤协作组(ECOG)评分、韩国预后指数(KPI)、SUV_max、MTV、TLG及治疗模式(单纯化疗/放化疗联合治疗)是患者PFS率的影响因素(χ²值：5.466～27.163，均P<0.05)；B症状、LDH、β₂微球蛋白、EB病毒(EBV)-DNA、超腔、ECOG评分、KPI、MTV、TLG和治疗模式是患者OS率的影响因素(χ²值：4.022～34.774，均P<0.05); SUV_max与OS率无关(χ²＝2.766, P>0.05)。多因素分析中，ECOG评分、MTV和TLG是影响患者PFS率的独立危险因素[相对危险度(RR)：5.107～6.802，均P<0.05]；ECOG评分、MTV、TLG和治疗模式是影响患者OS率的独立危险因素(RR: 0.221～9.106，均P<0.05)。

结论

治疗前¹⁸F-FDG PET/CT显像测得的MTV和TLG是影响Ⅰ～Ⅱ期ENKTL患者PFS及OS的独立预后因素，两者预测价值优于SUV_max。

引用本文: 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. DOI: 10.3760/cma.j.issn.2095-2848.2019.12.006.

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结外自然杀伤/T细胞淋巴瘤(extranodal natural killer/T-cell lymphoma, ENKTL)约占非霍奇金淋巴瘤的5%～15%，常见发病部位为上呼吸消化道，多位于鼻腔和韦氏环，以Ⅰ～Ⅱ期病变为主^[1]。大部分ENKTL初诊时多为Ⅰ～Ⅱ期，临床多称为早期。早期ENKTL患者的5年生存率可达70%～80%，但约20%～30%的患者在一线治疗后出现复发或进展^[2]。寻找简便、有效的预后评价指标，以便制订个体化治疗方案，提高患者的生存率和生存时间，是目前的研究热点。¹⁸F-脱氧葡萄糖(fluorodeoxyglucose, FDG) PET/CT显像已成为淋巴瘤分期、疗效判断及预后评价的重要手段^[3]，其在判断ENKTL预后方面的报道少见。Ⅲ～Ⅳ期ENKTL患者的治疗模式与Ⅰ～Ⅱ期不同，且预后明显较差。本研究回顾性分析了67例Ⅰ～Ⅱ期ENKTL患者的¹⁸F-FDG PET/CT显像资料和临床资料，旨在探讨治疗前¹⁸F-FDG PET/CT代谢参数对早期ENKTL患者的预后价值。

贡献者信息

汤泊

沭阳县中医院影像科，江苏省宿迁市　223600

周锦

沭阳县中医院影像科，江苏省宿迁市　223600

郭喆

南京医科大学第一附属医院核医学科　210029

李天女

南京医科大学第一附属医院核医学科　210029

丁重阳

南京医科大学第一附属医院核医学科　210029

通信作者

丁重阳

南京医科大学第一附属医院核医学科　210029

Email：chongyangding@126.com

关键词

淋巴瘤，结外NK-T细胞; 正电子发射断层显像术; 体层摄影术，X线计算机; 脱氧葡萄糖;

利益冲突

利益冲突　所有作者均声明不存在利益冲突

历史

出版日期：2019-12-25

收稿日期：2019-09-16

Clinical Investigation

Prognostic value of pretreatment ¹⁸F-FDG PET/CT imaging metabolic parameters in patients with early-stage extranodal natural killer/T cell lymphoma

Bo Tang, Jin Zhou, Zhe Guo, Tiannyu Li, Chongyang Ding

Published 2019-12-25

Cite as Chin J Nucl Med Mol Imaging, 2019, 39(12): 732-738. DOI: 10.3760/cma.j.issn.2095-2848.2019.12.006

Abstract

Objective

To investigate the prognostic value of metabolic parameters calculated from pretreatment ¹⁸F-fluorodeoxyglucose (FDG) PET/CT images in patients with extranodal natural killer/T cell lymphoma (ENKTL) of stage Ⅰ-Ⅱ.

Methods

From August 2010 to April 2018, 67 patients with ENKTL of stage Ⅰ-Ⅱ disease (47 males, 20 females; median age 57 years) in the First Affiliated Hospital of Nanjing Medical University were enrolled, and the clinic data and pretreatment ¹⁸F-FDG PET/CT imaging data were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of tumor tissue were calculated from PET/CT images with the threshold value of 40% of maximum standardized uptake value (SUV_max). The optimal cut-off values of progression-free survival (PFS) and overall survival (OS) of SUV_max, MTV and TLG were investigated by using receiver operating characteristic (ROC) curve analysis. Kaplan-Meier method, log-rank test and Cox proportional hazards model were used for data analysis.

Results

SUV_max, MTV and TLG of 67 patients were 12.32(8.65, 16.96), 13.13(7.37, 22.74) ml, 92.17(46.54, 198.46), respectively. ROC curve analysis showed that the cut-off values of SUV_max, MTV and TLG were 13.09, 18.05 ml and 152.81, respectively. Univariate analysis showed that B symptoms, lactate dehydrogenase (LDH) level, β₂-microglobulin, Eastern Cooperative Oncology Group (ECOG) score, Korean prognostic index (KPI), SUV_max, MTV, TLG and treatment mode (chemotherapy or chemoradiotherapy) were relative factors affecting PFS (χ²: 5.466-27.163, all P<0.05). B symptoms, LDH level, β₂-microglobulin, EB virus (EBV)-DNA, extra-cavitary extension, ECOG score, KPI, MTV, TLG and treatment mode were relative factors affecting OS (χ²: 4.022-34.774, all P<0.05). SUV_max was not the influencing factor of OS(χ²=2.766, P>0.05). Multivariate analysis showed that ECOG score, MTV and TLG were independent prognostic predictors of PFS (relative ratio (RR): 5.107-6.802, all P<0.05), and ECOG score, MTV, TLG and treatment mode were independent prognostic predictors of OS (RR: 0.221-9.106, all P<0.05).

Conclusions

MTV and TLG from pretreatment ¹⁸F-FDG PET/CT images are independent prognostic factors for PFS and OS in patients with ENKTL of stage Ⅰ-Ⅱ. MTV and TLG may be more useful than SUV_max for prognosis.

Key words:

Lymphoma, extranodal NK-T cell; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Contributor Information

Bo Tang

Department of Radiology, Shuyang Traditional Chinese Medicine Hospital, Suqian 223600, China

Jin Zhou

Department of Radiology, Shuyang Traditional Chinese Medicine Hospital, Suqian 223600, China

Zhe Guo

Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

Tiannyu Li

Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

Chongyang Ding

Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

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