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

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

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(SUVmax)的40%作为阈值,获得全身肿瘤的SUVmax、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SUVmax、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)、SUVmax、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);SUVmax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SUVmax。

ObjectiveTo 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 stageⅠ-Ⅱ.MethodsFrom August 2010 to April 2018,67 patients with ENKTL of stageⅠ-Ⅱdisease(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(SUVmax).The optimal cut-off values of progression-free survival(PFS)and overall survival(OS)of SUVmax,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.ResultsSUVmax,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 SUVmax,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),SUVmax,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).SUVmax 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).ConclusionsMTV and TLG from pretreatment 18F-FDG PET/CT images are independent prognostic factors for PFS and OS in patients with ENKTL of stageⅠ-Ⅱ.MTV and TLG may be more useful than SUVmax for prognosis.