初诊多发性骨髓瘤患者^(18)F-FDG PET/CT影像学表现与高危细胞遗传学异常的相关性及预后评估

Correlation and prognosis evaluation of^(18)F-FDG PET/CT imaging findings with high-risk cytogenetic abnormalities in newly diagnosed multiple myeloma patients

目的探讨初诊多发性骨髓瘤(MM)患者的^(18)F-氟脱氧葡萄糖(FDG)PET/CT影像学表现与高危细胞遗传学异常(HRCA)的相关性及二者联合应用于MM患者预后评估中的价值。方法回顾性分析2016年6月至2020年11月于汕头市中心医院经骨髓组织病理学检查和实验室检查确诊为MM并于治疗前行^(18)F-FDG PET/CT显像的44例患者的临床资料和影像学资料,其中男性23例、女性21例,年龄38~91(61.1±9.6)岁。根据荧光原位杂交检测结果将患者分为有HRCA组和无HRCA组;根据国际骨髓瘤工作组发布的修订版国际分期系统(R-ISS)分期标准将患者分为Ⅰ期+Ⅱ期和Ⅲ期2组;根据Mayo骨髓瘤分层级风险调整治疗(mSMART)3.0危险度分层标准将患者分为标危组和高危组。分析所有患者的^(18)F-FDG PET/CT显像资料,根据局灶病变(FLs)个数≤3或>3、最大标准化摄取值(SUVmax)≤4.2或>4.2和有无髓外病变(EMD)分别将患者各分为2组。随访结束后统计患者的无进展生存(PFS)期和总生存(OS)期。采用χ^(2)检验比较MM患者的^(18)F-FDG PET/CT影像学表现与临床特征、HRCA和分期的差异;采用多因素Logistic回归分析MM患者HRCA、R-ISS分期和mSMART 3.0分期的独立危险因素;采用Kaplan-Merier和Log-rank检验比较组间PFS期和OS期的差异;采用Cox比例风险回归模型分析MM患者PFS期和OS期的独立预后不良因素。结果FLs个数≤3或>3在不同R-ISS分期、不同mSMART 3.0分期和有无HRCA组间的差异均有统计学意义(χ^(2)=4.919、8.472、8.167,均P<0.05);有无EMD在不同mSMART 3.0分期和有无HRCA组间的差异均有统计学意义(χ^(2)=4.061、6.808,均P<0.05)。FLs个数>3是HRCA、R-ISS分期和mSMART 3.0分期的独立危险因素(OR=10.952、5.000、10.714,95%CI:1.195~100.393、1.127~22.181、2.269~50.598,均P<0.05)。有无EMD和有无HRCA组间PFS期和OS期的差异均有统计学意义(PFS期:χ^(2)=8.572、9.023,均P<0.01;OS期:χ^(2)=6.030、4.877,均P<0.05)。EMD是PFS期和OS期的独立预后不良因素(OR=4.466、6.520,95%CI:1.084~18.396、1.174~36.211,均P<0.05);HRCA是PFS期的独立预后不良因素(OR=8.458,95%CI:1.671~42.812,P<0.05)。截至随访结束,无EMD且无HRCA或仅存在两者之一的患者,均未达到中位PFS期和中位OS期;同时存在EMD和HRCA的患者中位PFS期为11个月(χ^(2)=20.903,P<0.001),中位OS期为17个月(χ^(2)=10.656,P<0.01)。结论初诊MM的患者的^(18)F-FDG PET/CT影像学表现与HRCA存在相关性,二者联合应用对MM患者的预后评估有一定的预测价值。

Objective To investigate the correlation between 18F-fluorodeoxyglucose(FDG)PET/CT imaging findings and high-risk cytogenetic abnormalities(HRCA)in patients newly diagnosed with multiple myeloma(MM),and the value of both combined applications in evaluating the prognosis of patients with MM.Methods The clinical and imaging data of 44 patients with MM diagnosed by bone marrow histopathology and laboratory examination and who underwent 18F-FDG PET/CT imaging before treatment in Shantou Central Hospital from June 2016 to November 2020 were retrospectively analyzed,including 23 males and 21 females,aged 38–91(61.1±9.6)years old.Patients were divided into the HRCA group and the non-HRCA group according to the result of fluorescence in situ hybridization.Patients were divided into stageⅠ+Ⅱgroup and stageⅢgroup according to the Revised-International Staging System(R-ISS)issued by the International Myeloma Working Group.Patients were divided into two groups,a standard-risk group,and a high-risk group according to the Mayo Stratification of Myeloma and Risk-adapted Therapy(mSMART)3.0 risk stratification criteria.Through the analysis of the 18F-FDG PET/CT imaging data,patients were divided into≤3 groups and>3 groups according to the number of focal lesions(FLs),divided into≤4.2 groups and>4.2 groups according to maximum standardized uptake value(SUVmax),divided into extramedullary disease(EMD)group and non-EMD group according to the presence of EMD lesions,respectively.Gather data on progression-free survival(PFS)and overall survival(OS)begins from the first follow-up.Imaging findings with clinical features,HRCA,and prognostic stages were compared using theχ^(2)test.The independent risk factors of HRCA and stages were analyzed using the multivariate logistic regression analysis.The differences between PFS and OS among the groups were compared using the Kaplan-Meier method and Log-rank test.The independent risk factors of PFS and OS were analyzed using the Cox proportional hazards regression model.Results FLs≤3 or>3 varied among groups of R-ISS,mSMART 3.0,and HRCA(χ^(2)=4.919,8.472,8.167;all P<0.05).EMD or non-EMD varied among groups of mSMART 3.0 and HRCA(χ^(2)=4.061,6.808;both P<0.05).FLs>3 were independent risk factors for HRCA,R-ISS,and mSMART 3.0(OR=10.952,5.000,10.714;95%CI:1.195–100.393,1.127–22.181,2.269–50.598;all P<0.05).PFS and OS varied among groups of EMD and HRCA(PFS:χ^(2)=8.572,9.023;both P<0.01 and OS:χ^(2)=6.030,4.877;both P<0.05).EMD was an independent poor prognosis factor for both PFS and OS(OR=4.466,6.520;95%CI:1.084–18.396,1.174–36.211;both P<0.05).HRCA was an independent poor prognosis factor for PFS(OR=8.458,95%CI:1.671–42.812,P<0.05).By the end of follow-up,patients without EMD and HRCA or only one of them had not reached median PFS and median OS;median PFS for patients with both EMD and HRCA was 11 months(χ^(2)=20.903,P<0.001)and median OS were 17 months(χ^(2)=10.656,P<0.01).Conclusion There is a significant correlation between 18F-FDG PET/CT imaging findings and HRCA in patients newly diagnosed with MM,and the combination of both has a certain predictive value for the prognosis of patients with MM.