18F-脱氧葡萄糖正电子发射计算机断层显像对淋巴瘤分期和预后评估的作用

Role of 18fluoro-deoxyglucose positron emission tomography on staging and predicting outcome in patients with lymphoma

目的探讨18F-脱氧葡萄糖正电子发射计算机断层显像（FDG-PET）对淋巴瘤患者分期及预后评估的作用。方法对初诊的41例淋巴瘤患者，化疗前和化疗4个疗程后行FDG—PET，中位随访30个月，比较化疗前FDG．PET分期和化疗4个疗程后FDG．PET结果对预后的影响。结果41例患者治疗前结内、外病灶的最大标准摄取值（SUVmax）分别为9．7±6．9和8．4±6．8。侵袭性非霍奇金淋巴瘤（NHL）和惰性NHL比较，结内、外病灶的SUVmax值差异有统计学意义（侵袭性NHL分别为10．3±7．5和9．1±6．5，惰性NHL分别为4．7±2．1和2．4±0．6，均P〈0．05）。NHL和霍奇金淋巴瘤（HL）、B细胞和T细胞NHL、活化B与生发中心来源弥漫大B细胞淋巴瘤治疗前FDG．PET的SUVmax差异无统计学意义（P〉O．05）。化疗前22例（54％）患者FDG—PET检出结外器官病变；6例（15％）因FDG—PET发现CT等其他检查未显示的淋巴结或结外病变而提高临床分期。治疗前经FDG．PET分期为Ⅰ、Ⅱ期的患者15例（37％），Ⅲ、Ⅳ期的患者26例（63％）。随访期间，FDG—PET分期Ⅰ、Ⅱ期的患者中1例（7％）因疾病进展死亡，Ⅲ、Ⅳ期的患者中6例（23％）因疾病进展死亡。41例患者化疗4个疗程后行FDG—PET检查，FDG—PET阴性的患者17例（41％）中，随访期间1例（6％）因疾病复发死亡，FDG-PET阳性的患者24例（59％）中，随访期间6例（25％）因疾病进展死亡。结论化疗前FDG-PET检查有助于对淋巴瘤患者进行准确的临床分期，化疗4个疗程后FDG．PET检查有助于评估淋巴瘤患者的预后。指导进一步治疗。

Objective To evaluate the application of 18flnoro-deoxyglucose positron emission tomography （FDG-PET） to the staging and predicting outcome in patients with lymphoma. Methods 41 patients with newly diagnosed lymphoma （median age 57 years） were explored with FDG-PET prior to and after 4 cycles of chemotherapy. With a median follow-up of 30 months （range 10-68 months）,the value of FDG-PET to staging and predicting clinical outcome was assessed. Results The maximum standardized uptake value （SUVmax） of nodal and extranodal lesions was 9.7＋6.9 and 8.4＋6.8 respectively prior to treatment. There were significant difference （P〈0.05） in aggressive non-Hodgkin＇s lymphoma and indolent non-Hodgkin＇s lymphoma, no significant difference （P〉0.05） in non-Hodgkin＇s lymphoma and Hodgkin＇s lymphoma （HL）, B-cell neoplasms and T-cell neoplasms, germinal center B-cell-like DLBCL and activated B-cell-like DLBCL. In 41 patients, 22 patients （54 %）were detected extranodal focus by FDG-PET before chemotherapy. FDG-PET imaging upstaged in 6（15%）of initial lymphoma patients. There were 15 patients （37 %） in stage Ⅰ and Ⅳ and 26 patients（63 %）in stage Ⅲ and Ⅳ by FDG-PET scan.1 patient （7 %） in stage Ⅰ and Ⅱ ,6 patient （23 %） in stage Ⅲ and Ⅳ died of disease progression during follow-up. After 4 cycles of chemotherapy, the FDG- PET was negative in 41%（17/41）, positive in 59 %（24/41） respectively. 1 patient（6 %）died of disease relapse among 17 patients who were FDG-PET negative, 6 patient （25 % ）died of disease progression among 24 patients who were FDG-PET positive during follow-up. Conclusion FDG-PET scanning plays an important role in the pretreatment staging and prediction of the prognosis after 4 cycles of chemotherapy in patients with lymphoma. Thus it may offer the potential for change in treatment paradigms.