PET/CT检查对结外自然杀伤细胞/T细胞淋巴瘤预后评估的价值

Value of PET/CT in the prognosis of extranodal NK/T cell lymphoma

目的探讨正电子发射计算机断层显像/X线计算机体层成像（PET/CT）检测在结外自然杀伤细胞/T细胞淋巴瘤（NK/TCL）临床预后判断中的应用价值。 方法选取首都医科大学附属北京同仁医院病理科2007年1月至2016年7月间确诊、并于初诊时进行PET/CT检查的72例NK/TCL住院病例，回顾性分析PET/CT检测结果。采用Kaplan－Meier方法分析PET/CT发现的阳性指标与总生存期的关系。 结果男54例，女18例，中位年龄44.5岁，中位随访时间29.2个月。发病部位：单侧鼻腔26例（36.1%），双侧鼻腔36例（50.0%），鼻咽、口咽及喉咽10例（13.9%）。51例（70.8%）累及周围组织：累及鼻翼29例（40.3%）、鼻窦29例（40.3%）、颌面部软组织18例（25.0%）、眼眶12例（16.7%）、上下颌骨及颅底骨8例（11.1%）、眼睑6例（8.3%）、脑组织3例（4.2%）、眼球2例（2.8%）。颈部及腹股沟淋巴结肿大54例（75.0%）、脾大10例（13.9%）、肝大2例（2.8%）。Kaplan－Meier单因素生存分析发现临床分期和国际预后指数（IPI）均分别与预后相关（均P〈0.05），颌面部软组织、眼睑、眼眶、颌骨及颅底骨及脑组织受累的患者的总生存时间与未受累者相比，差异均有统计学意义（均P〈0.05），扁桃体及腭部、鼻翼鼻根及鼻前庭、鼻窦受累者与未受累者，总生存差异均无统计学意义（均P〉0.05）。Cox回归模型多因素分析显示颌骨及颅底受累为独立不良预后因素（P〈0.05）。 结论PET/CT检查能通过显示肿物结构及代谢状况两方面的因素，准确地检测出结外NK/TCL的肿瘤侵犯相邻及远隔组织的范围，对临床分期及预后判断具有重要价值。

ObjectiveTo explore the value of Positron-Emission Tomography/Computed Tomography（PET/CT）in the prognosis of extranodal NK/T cell lymphoma. MethodsThe patients of NK/T cell lymphoma diagnosed from January 2007 to July 2016 in Department of Pathology of Beijing Tongren Hospital were enrolled in this study.Seventy-two in-hospital patients were examined on the invasion of adjecent tissue or organ by PET/CT.The PET/CT results were analyzed retrospectively.Kaplan-Meier method was used to analyze the prognostic value of the positive results by PET/CT on overall survival（OS）. ResultsThere were 54 males and 18 females with median age of 44.5 years（13-75 years）.According to Ann Arbor staging system,there were 16 cases（22.2%）in stage Ⅰ,29 cases（40.3%）in stage Ⅱ,6 cases（8.3%）in stage Ⅲ and 21 cases（29.2%）in stage Ⅳ.According to the IPI scoring system,there were 34 cases（47.2%）in the low risk group（0-1 point）,21 cases（29.2%）in the low-middle risk group（2 points）,16 cases（22.2%）in the middle-high risk group（3 points）,and 1 case（1.4%）in the high risk group（4-5 points）.The median follow-up time was 29.2 months（1-118 months）.The disease occured in unilateral nasal cavity in 26 cases（36.1%）,bilateral nasal cavities in 36 cases（50.0%）,nasopharynx,oropharynx and pharynx in 10 cases（13.9%）.The tumors of 51 cases involved the surrounding tissue,including nasal wings in 29 cases（40.3%）,nasal sinus in 29 cases（40.3%）,maxillofacial soft tissue in 18 cases（25.0%）,orbital in 12 cases（16.7%）,maxilla and skull base in 8 cases（11.1%）,eyelid in 6 cases（8.3%）,brain tissue in 3 cases（4.2%）,eyeball in 2 cases（2.8%）.In addition,cervical and inguinal lymphadenopathy were found in 54 cases（75.0%）.Splenomegaly and hepatomegaly were found in 10 cases（13.9%）and 2 cases（2.8%）,respectively.Survival analysis showed that the clinical stage and IPI were significantly associated the clinical prognosis（P=0.000,0.001,respectively）.Involvement of the maxillofacial soft tissue,eyelid,orbital,maxilla and skull base and brain tissue were significantly related to reduced the overall survival time（P=0.006,0.000,0.024,0.001 and 0.015,respectively）.Involvement of palate or tonsil,the nosewingand nasal sinus did not show significant shorter overall survival（P=0.091,0.063,and 0.139,respectively）.Cox regression multivariate analysis showed maxilla and skull base involvement was independent adverse prognostic factor（P=0.047）. ConclusionsThe PET/CT examination can accurately detect the extent of adjacent and distant tissues of tumor involvement of NK/T cell lymphoma by showing the tumor structure and metabolic status,thus has important value in the clinical staging and prognosis predication.