结外NK/T细胞淋巴瘤治疗前正电子发射计算机断层扫描显像中骨髓18F-脱氧葡萄糖摄取形态预测预后的价值

Prognostic value of bone marrow 18F-FDG uptake pattern of pretreatment PET-CT in extranodal NK/T cell lymphoma

目的探讨初诊结外NK/T细胞淋巴瘤(ENKTL)治疗前18F-脱氧葡萄糖(18F-FDG)正电子发射计算机断层扫描(PET-CT)显像中骨髓摄取形态预测预后的价值。方法回顾性分析63例Ⅱ~Ⅳ期ENKTL患者的临床病理资料,全组患者治疗前均行骨髓活检和18F-FDG PET-CT检查。以正常肝脏组织18F-FDG摄取为标准,将患者分为骨髓18F-FDG摄取增高局灶型、弥漫型和摄取正常型。采用Kaplan-Meier法和log rank检验进行单因素生存分析,多因素生存分析采用Cox比例风险模型。结果63例患者中,PET-CT显像中骨髓18F-FDG摄取正常型22例,骨髓18F-FDG摄取增高弥漫型24例,骨髓18F-FDG摄取增高局灶型17例。骨髓活检诊断骨髓浸润阴性55例,阳性8例。63例患者中,复发进展37例,死亡31例。骨髓18F-FDG摄取增高局灶型和正常型患者的3年无进展生存率分别为14.7%和63.6%(P=0.006),3年总生存率分别为18.8%和64.8%(P=0.005)。骨髓18F-FDG摄取增高弥漫型和正常型患者的3年无进展生存率分别为35.3%和63.6%(χ2=1.968,P=0.161),3年总生存率分别为47.9%和64.8%(P=0.280)。单因素生存分析结果示,乳酸脱氢酶、EB病毒(EBV)DNA、韩国预后指数、骨髓18F-FDG摄取形态均与患者的无进展生存和总生存有关(均P<0.05);多因素生存分析结果示,EBV-NDA、骨髓18F-FDG摄取形态为影响患者无进展生存的独立危险因素(均P<0.05),EBV-DNA是影响患者总生存的独立危险因素(P<0.05)。结论ENKTL患者治疗前18F-FDG PET-CT显像中骨髓摄取形态对患者预后评估具有一定的价值,骨髓18F-FDG摄取增高局灶型是影响患者无进展生存的独立危险因素。

Objective To investigate the prognostic value of bone marrow(BM)18F-fluorodeoxyglucose(18F-FDG)uptake pattern of pretreatment positron emission tomography/computed tomography(PET-CT)in extranodal NK/T cell lymphoma(ENKTL)patients.Methods We retrospectively collected clinical data from a series of 63 ENKTL patients with stageⅡ~Ⅳ,who have received both 18F-FDG PET-CT and bone marrow biopsy(BMB)prior to treatment.According the BM 18F-FDG uptake pattern of PET-CT,the patients were divided into three groups:focal BM FDG uptake higher than liver(fPET+),diffuse BM uptake higher than liver(dPET+)and normal BM uptake(lower than liver)(nPET).The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis,and COX proportional hazards model for multivariate analysis.Results Among the 63 patients,22 patients had nPET,24 patients showed dPET+,and 17 patients had fPET+.BMB positive was found in 8 patients,and negative in 55 patients.Thirty-seven patients had disease progression or relapse,and 31 patients died.The 3-years progression free survival(3y-PFS)rates of fPET+patients and nPET patients were 14.7%and 63.6%(P=0.006).The 3-years overall survival(3y-OS)rates were 18.8%and 64.8%(P=0.005).The 3y-PFS of dPET+patients and nPET patients were 35.6%and 63.6%(P=0.161),3y-OS were 47.9%and 64.8%(P=0.280).Univariate analysis showed that lactate dehydrogenase(LDH)level,Epstein-Barr virus DNA(EBV-DNA),Korean prognostic index(KPI)and BM 18F-FDG were related with PFS and OS(all P<0.05).Multivariate analysis showed EBV-DNA and BM 18F-FDG were independent predictors for PFS(P<0.05).EBV-DNA was also an independently predictor for OS(P<0.05).Conclusions PET/CT-directed BM patterns are meaningful in predicting prognosis of newly diagnosed ENKTL patients.Focal BM 18F-FDG uptake pattern is an independent predictor for PFS.