乔文礼; 牛家华; 金文雅; 邢岩; 汪太松; 宋建华; 赵晋华

doi:10.3760/cma.j.cn321828-20190729-00149

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• 临床研究 •

自体干细胞移植前或后¹⁸F-FDG PET/CT显像及相关因素对经典霍奇金淋巴瘤预后的评估价值

中华核医学与分子影像杂志, 2020,40(3) : 147-152. DOI: 10.3760/cma.j.cn321828-20190729-00149

摘要

目的

探讨经典霍奇金淋巴瘤(cHL)患者在自体干细胞移植(ASCT)前或后行¹⁸F-脱氧葡萄糖(FDG)PET/CT显像及相关因素的预测预后价值。

方法

回顾性收集2008年1月至2017年6月间在上海交通大学附属第一人民医院经病理检查证实的55例cHL患者[男28例，女27例，年龄(28.8±9.6)岁]，其中43例在ASCT前、34例在ASCT后行¹⁸F-FDG PET/CT显像(22例在移植前后均行显像)。依据Deauville五分法分别将ASCT前或后PET/CT显像结果分为阳性(≥4分)和阴性组(<4分)。采用Kaplan-Meier法绘制生存曲线，分析无进展生存(PFS)和总生存(OS)，并通过log-rank检验比较组间差异；通过Cox回归模型计算生存影响因素的风险比(HR)。

结果

55例cHL患者中，29例(53%)中位随访8个月后病情进展，11例(20%)在中位随访29.5个月后死亡；3年PFS率为46.4%，OS率为84.5%。有无B症状组间，有无纵隔大肿块组间，国际预后评分(IPS)低危组(0～2分)与高危组(3～7分)组间，挽救性化疗完全缓解(CR)、部分缓解(PR)或疾病稳定(SD)、疾病进展(PD)组间，ASCT前显像阴性与阳性组间，ASCT后显像阴性与阳性组间PFS率差异均有统计学意义[χ²值：5.52～20.01, HR：2.21(95% CI：1.56～3.12)～5.51(95% CI：1.86～16.33)，均P<0.05]。有无B临床症状和有无纵隔大肿块对预测OS有统计学意义[HR＝5.28(95% CI：1.14～24.51)和4.27(95% CI：1.24～14.79)，均P<0.05]。ASCT前、后¹⁸F-FDG PET/CT显像结果联合对预测PFS具有统计学意义(χ²＝11.28，P<0.01)。多因素分析显示ASCT后¹⁸F-FDG PET/CT显像阳性患者的进展风险明显高于显像阴性患者(HR＝6.20，P<0.01)；有B症状患者死亡的风险明显高于无B临床症状患者(HR＝5.28，P<0.05)。

结论

ASCT后¹⁸F-FDG PET/CT显像结果能有效预测cHL患者ASCT后的PFS，有无B症状是预测ASCT后OS的重要指标。

引用本文: 乔文礼, 牛家华, 金文雅, 等. 自体干细胞移植前或后¹⁸F-FDG PET/CT显像及相关因素对经典霍奇金淋巴瘤预后的评估价值 [J] . 中华核医学与分子影像杂志, 2020, 40(3) : 147-152. DOI: 10.3760/cma.j.cn321828-20190729-00149.

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经典霍奇金淋巴瘤(classic Hodgkin lymphoma, cHL)是霍奇金淋巴瘤(Hodgkin lymphoma, HL)的主要类型，约占HL的95%，化疗及局部小范围放疗可使80%的患者达到长期治愈^[1]。对于复发难治性cHL患者，大剂量化疗后行自体干细胞移植(autologous stem cell transplantation, ASCT)是目前常用的治疗模式，但有50%的患者在ASCT后复发，因此及时评价ASCT疗效和预测预后尤为重要^[2,3]。系统综述相关研究表明，HL患者ASCT前行¹⁸F-脱氧葡萄糖(fluorodeoxyglucose, FDG)PET/CT显像能预测预后，然而各项纳入研究预测预后的效能差别较大，一部分研究同时包含了非HL或少量行异基因干细胞移植的病例，而且影响ASCT预后的因素较多，若能与临床症状、挽救性化疗效果等其他因素同时分析对预后的影响则更有意义^[3]。本研究拟探讨cHL患者ASCT前或后行¹⁸F-FDG PET/CT显像及相关因素的预测预后价值。

贡献者信息

乔文礼

上海交通大学附属第一人民医院核医学科　200080

牛家华

上海交通大学附属第一人民医院血液科　200080

金文雅

上海交通大学附属第一人民医院核医学科　200080

邢岩

上海交通大学附属第一人民医院核医学科　200080

汪太松

上海交通大学附属第一人民医院核医学科　200080

宋建华

上海交通大学附属第一人民医院核医学科　200080

赵晋华

上海交通大学附属第一人民医院核医学科　200080

通信作者

赵晋华

上海交通大学附属第一人民医院核医学科　200080

Email：zhaojinhua1963@126.com

关键词

淋巴瘤; 干细胞; 移植，自体; 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;

基金项目

上海市科学技术委员会科研计划项目（17411953200）

上海市申康医院发展中心临床科技创新项目（SHDC22015032）

利益冲突

所有作者均声明不存在利益冲突

历史

出版日期：2020-03-25

收稿日期：2019-07-29

Clinical Investigation

Prognostic value of ¹⁸F-FDG PET/CT imaging and related factors for patients with classic Hodgkin lymphoma before or after autologous stem cell transplantation

Qiao Wenli, Niu Jiahua, Jin Wenya, Xing Yan, Wang Taisong, Song Jianhua, Zhao Jinhua

Published 2020-03-25

Cite as Chin J Nucl Med Mol Imaging, 2020, 40(3): 147-152. DOI: 10.3760/cma.j.cn321828-20190729-00149

Abstract

Objective

To assess the predictive value of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT imaging and relevant factors in the prognosis of patients with classic Hodgkin lymphoma (cHL) before or after autologous stem cell transplantation (ASCT).

Methods

From January 2008 to June 2017, 55 cHL patients (28 males, 27 females; age: (28.8±9.6) years) confirmed by pathology in Shanghai General Hospital were retrospectively included. ¹⁸F-FDG PET/CT imaging was performed before ASCT in 43 cases and after ASCT in 34 cases (22 patients underwent the imaging both before and after ASCT). Patients were divided into positive group (≥4) and negative group (<4) according to¹⁸F-FDG PET/CT imaging results using Deauville 5-point scale. The predictive value of relevant factors in the prognosis was evaluated with progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis and log-rank test. Hazard ratio (HR) was calculated by Cox regression model.

Results

Of 55 cHL patients, 29 (53%) had a progression of disease after a median follow-up of 8 months, and 11 (20%) patients died after a median follow-up of 29.5 months, with the 3-year PFS rate of 46.4% and OS rate of 84.5%. Significant differences of PFS rate were found between patients with or without B symptoms, between patients with or without large mediastinal mass, between patients with international prognostic score (IPS) of 0-2 and those with IPS of 3-7, among patients with different effect of salvage chemotherapy (complete remission (CR), partial remission (PR) + stable disease (SD), progressive disease (PD)), and between patients with negative or positive PET/CT imaging results before or after ASCT (χ² values: 5.52-20.01, HR: 2.21(95% CI: 1.56-3.12)-5.51(95% CI: 1.86-16.33), all P<0.05). B symptoms and large mediastinal mass were also prognostic factors for OS rate (HR: 5.28(95% CI: 1.14-24.51) and 4.27(95% CI: 1.24-14.79), both P<0.05). The combination of¹⁸F-FDG PET/CT imaging before and after ASCT was statistically significant for predicting PFS (χ²=11.28, P<0.01). Multivariate survival analysis showed that the risk of progression in patients with positive PET/CT results after ASCT was significantly higher than those with negative results (HR=6.20, P<0.01), and the risk of death in patients with B symptoms was significantly higher than those without B symptoms (HR=5.28, P<0.05).

Conclusion

¹⁸F-FDG PET/CT imaging results after ASCT have important values for predicting PFS in cHL patients after ASCT, and B symptoms can be used as an important prognostic indicator of OS after ASCT.

Key words:

Lymphoma; Stem Cells; Transplantation, autologous; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Contributor Information

Qiao Wenli