^(18)F-FDG符合线路显像评价非霍奇金淋巴瘤早期疗效及预后

^(18)F-FDG coincidence SPECT imaging for early evaluation of response to chemotherapy and prognosis in non-Hodgkin′s lymphoma

目的探讨^(18)F-脱氧葡萄糖(FDG)符合线路显像在评价非霍奇金淋巴瘤(NHL)早期疗效和预后中的价值。方法 48例经病理检查证实为 NHL 的患者在化疗早期(2～5个疗程后)行^(18)F-FDG 符合线路显像,将患者分为2组:第1组显像阳性(23例),第2组显像阴性(25例)。对2组患者早期疗效行临床评估,用 Kaplan-Meier 单因素分析法行患者无进展生存期(PFS)分析,并对影响 PFS 与预后的因素行 Cox 回归分析。结果 (1)第1组完全缓解1例,部分缓解6例,未缓解5例,进展11例;第2组完全缓解20例,部分缓解4例,进展1例。显像改变了21%(10/48)患者的治疗方案。(2)Kap-lan-Meier 单因素分析示,第1组患者2年无进展生存率为12.8%,第2组为78.0%;^(18)F-FDG 显像阳性与阴性的病例其 PFS 差异有统计学意义(P<0.0001)。Cox 回归分析示^(18)F-FDG 显像对预测 PFS 的作用具有统计学意义(P<0.001),且独立于其他变量。(3)显像与 X 线胸片、CT、MRI、B 超等同期检查比较,两者评估准确性分别为85.4%、66.7%,阳性预测值为91.3%、68.0%。结论 ^(18)F-FDG 符合线路显像对评估 NHL 早期治疗反应与预后均有重要作用。

Objective Evaluation of therapeutic response in lymphoma is of great clinical significance. The current study employed ^18F-fluorodeoxyglucose（FDG） coincidence SPECT imaging to evaluate response and to predict prognosis of patients with non-Hodgkin＇s lymphoma （NHL） at early stage of chemotherapy. Methods is F-FDG coincidence SPECT imaging was performed in 48 patients with pathologically confirmed NHL. The patients were divided into two groups based on the FDG scanning results at the early stage after chemotherapy. The follow-up lasted for 8 -43 months and the progression free survival （PFS） analysis was undertaken. Twenty-three cases with positive ^18F-FDG scans consisted of group 1 and 25 with negative scans in group 2. Results The clinical outcome of those patients varied as their PET results differed. In group 1,7 eases were in clinical remission and 11 in progression. In group 2, there were 24 cases with clinical remission and 1 progression. ^18F-FDG imaging led to changes on therapeutic strategy in 21% （ 10/48 ） of the patients. The estimated 2 year PFS rate was 12.8% in group 1, and 78.0% in group 2. Kaplan- Meier survival analyses showed a strong correlation between FDG results and PFS （ P 〈 0. 0001 ）. Cox regression analyses indicated that early is F-FDG scan after chemotherapy was an independent prognostic factors （ P 〈 0. 001 ）. The accuracy （ 85.4% ） and positive positive predictive value （ 91.3 % ） with is F-FDG coincidence SPECT imaging were higher than that with conventional imaging （66.7% and 68.0% , respec- tively）. Conclusion Early ^18F-FDG scan after chemotherapy may be valuable in early assessment of response to chemotherapy and the prognosis in NHL.