18F-FDGPET-CT及其他临床病理因素对套细胞淋巴瘤预后的预测价值

Prognostic value of ^(18)F-fluoro-deoxyglucose positron emission tomography-computed tomography and some clinicopathological factors for mantle cell lymphoma

目的 :探讨氟代脱氧葡萄糖正电子发射体层摄影术-计算机体层摄影术(18F-l uoro-deoxyglucose positron emission tomography-computed tomography,18F-FDG PET-CT)及其他临床病理因素对套细胞淋巴瘤(mantle cell lymphoma,MCL)预后的预测价值。方法 :回顾性分析2009年2月—2012年11月在北京大学肿瘤医院接受诊治的19例初治MCL患者的病历资料和随访资料,分析18F-FDG PET-CT及其他临床病理因素与MCL无进展生存(progression-free survival,PFS)和总生存(overall survival,OS)的关系。结果 :17例患者接受分期评估时的18F-FDG PET-CT均显示代谢增加,中位最大标准摄取值(maximum standardized uptake value,SUVmax)为7.4(范围:2.5~18.3)。在有骨髓侵犯的8例患者中,仅2例的18F-FDG PET-CT提示骨髓侵犯。18F-FDG PETCT的SUVmax与Ki-67(Ki-67≥30%vs<30%)无关(P>0.05)。中位随访时间为29个月(范围:3~58个月),估算3年OS率为71%,3年PFS率为74%。单因素分析显示,Ki-67和疗效与PFS(P=0.000、P=0.004)和OS(P=0.002、P=0.004)均明显相关,而国际预后指数(International Prognostic Index,IPI)、简化MCL国际预后指数(simplii ed MCL International Prognostic Index,sMIPI)和分期评估18F-FDG PET-CT的SUVmax均与PFS和OS无明显相关性(P>0.05)。COX比例风险回归模型分析显示,Ki-67、IPI、sMIPI、分期评估18F-FDG PET-CT的SUVmax和疗效均对预后无明显影响(P>0.05)。结论 :18F-FDG PET-CT作为MCL的检查手段之一,对骨髓侵犯的检出率较低。Ki-67和疗效可能与MCL患者的预后相关,但仍待大样本临床试验予以验证。

Objective： To investigate the prognostic value of 18F-fluoro-deoxyglucose positron emission tomography-computed tomography （18F-FDG PET-CT） and some clinicopathological factors for mantle cell lymphoma （MCL）. Methods： Clinical records and follow-up information of 19 untreated patients with MCL admitted in Peking University Cancer Hosipital between February 2009 and November 2012 were reviewed. The impacts of 18F-FDG PET-CT and some clinicopathological factors on progression-free survival （PFS） and overall survival （OS） were evaluated. Results： Seventeen patients had an 18F-FDG PET-CT with an abnormal uptake value [the median maximum standardized uptake value （SUVmax） was 7.4 （range： 2.5-18.3）. Bone marrow （BM） biopsies demonstrated disease in 8 patinets, but only 2 of them had 18F-FDG uptakes. There was no statistically significant relationship between SUVmax and Ki-67 （≥30% vs 〈 30%）. The median follow-up time was 29 months （range： 3-58） with an estimated 3-year PFS of 74% and an estimated 3-year OS of 71%. Univariate analysis showed that Ki-67 and response were associated with PFS （P = 0.000; P = 0.004） and OS （P = 0.002; P = 0.004）, but International Prognostic Index （IPI）, simplified MCL International Prognostic Index （sMIPI） and initial ~SF-FDG PET-CT SUVmax were not associated with PFS and OS （P 〉 0.05）. COX proportional-hazards regression model revealed that Ki-67, IPI, sMiPI, initial 18F-FDG PET-CT SUVmax and response were not associated with PFS and OS （P 〉 0.05）. Conclusion： 18F-FDG PET-CT at diagnosis is complementary to conventional evaluations, but BM biopsies remain mandatory. More large-sample clinical trials may be needed to further verify the association of Ki-67 and response with the prognosis of MCL.