^(18)F-FDG PET/CT显像及血管内皮生长因子对POEMS综合征放化疗联合自体干细胞移植的疗效

Effect of^(18)F-FDG PET/CT imaging and vascular endothelial growth factor in combination with autologous stem cell transplantation for POEMS syndrome

目的探讨^(18)F-FDG PET/CT显像、血管内皮生长因子(VEGF)在POEMS综合征放化疗联合自体干细胞移植治疗中的价值。方法回顾性分析2012年6月~2022年12月本院123例临床高度怀疑POEMS综合征患者临床及影像资料,最终纳入25例患者,经临床及病理确诊POEMS综合征21例,惰性淋巴瘤1例,多发性骨髓瘤3例。21例POEMS综合征患者分为单纯放化疗组(n=12)和放化疗联合自体干细胞移植治疗组(n=9),分析两组患者PET/CT影像特点、最大标准化摄取值(SUV_(max))、VEGF、白细胞介素6(IL-6)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,随访观察两组患者的治疗效果。结果21例POEMS综合征患者均伴有不同程度的多发性神经病变与单克隆浆细胞增殖性改变,皮肤病变10例。^(18)F-FDG PET/CT显像21例患者94个部位形态或代谢异常,SUV_(max)与VEGF水平呈正相关性(r=0.590,P=0.005),而SUV_(max)与FT3、FT4、TSH、IL-6水平均无相关性(P>0.05)。随访55.5±17.6月,治疗后VEGF水平较治疗前基线水平降低(1670.7±309.1 pg/mL vs2051.0±458.8 pg/mL,P<0.05);放化疗联合自体干细胞治疗组中位生存期与单纯放化疗组的差异无统计学意义(P=0.612)。结论PET/CT显像联合血清VEGF水平检测可作为POEMS综合征诊断、活动度监测及预后评估的无创方法,自体干细胞联合放化疗未明显延长POEMS综合征的中位生存期。

Objective To investigate the value of^(18)F-FDG PET/CT imaging and vascular endothelial growth factor(VEGF)in the radiochemotherapy combined with autologous stem cell transplantation treatment for POEMS syndrome.Methods A total of 123 patients'clinical and imaging data were retrospectively analyzed.The patients were clinically suspected of POEMS syndrome in the General Hospital of Northern Theater Command from June 2012 to December 2022.Eventually the study enrolled 25 patients.Among these,21 cases were clinically and pathologically diagnosed with POEMS syndrome,one case with indolent lymphoma,and three cases with multiple myeloma.The 21 patients with POEMS syndrome were divided into radiochemotherapy group(n=12)and radiochemotherapy combined with autologous stem cell transplantation group(n=9).Characteristics of PET/CT imaging,the maximum standardized uptake value(SUV_(max)),VEGF,interleukin-6(IL-6),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)levels of both groups were analyzed,and treatment efficacy was documented through follows-up.Results All 21 POEMS syndrome patients had varying degrees of polyneuropathy(21/21)and monoclonal plasma cell proliferative changes(21/21),10 case with skin changes.PET/CT imaging revealed morphological or metabolic abnormalities in 94 sites among the 21 patients.A positive correlation was found between SUV_(max) in^(18)F-FDG imaging and VEGF levels(r=0.590,P=0.005),whereas,there were no significant correlations between SUV_(max) and levels of FT3,FT4,TSH or IL-6(P>0.05).The average follows-up period was 55.5±17.6 months,and the post-treatment VEGF levels were significantly reduced compared to the pre-treatment baseline(1670.7±309.1 pg/mL vs 2051.0±458.8 pg/mL,P<0.05).The difference between median survival period in the radiochemotherapy combined with autologous stem cell transplantation group and radiochemotherapy group was not statistically significant(P=0.612).Conclusion PET/CT imaging combined with serum VEGF level could be used as a non-invasive method for the diagnosis,activity monitoring and prognosis assessment of POEMS syndrome.Autologous stem cells combined with chemoradiotherapy did not significantly prolong the median survival of POEMS syndrome.