中期18FDG-PET/CT检查在外周T细胞型淋巴瘤治疗中的临床应用及预后意义

2011年Lugano国际淋巴瘤会议（ICML） 关注PET在淋巴瘤中的应用篇 摘要048

中国肿瘤化疗 发布时间：16:46 2011-9-22武汉协和医院肿瘤中心刘红利

尽管18氟-脱氧葡萄糖（18F-FDG）PET /CT中期检查已被用于预测霍奇金淋巴瘤(HL)和弥漫大B淋巴瘤(DLBCL)的治疗疗效，但其对外周T细胞淋巴瘤(PTCL)预后的预测价值尚未明确。我们前瞻性采用一系列PET/CT检查评价疗效，以明确其能否提供更多的预后信息并成为PTCL治疗疗效的阳性预测指标。

病人和方法：2005年9月到2010年2月，在单个研究中心入组初诊的外周T细胞型淋巴瘤患者共63例。患者接受CHOP/CHOP样或其他方案化疗，分别于诊断时、治疗中和治疗结束后接受PET/CT检查。因为纵隔血管结构的SUV最大临界值为3.0，故任何代谢强度低于或等于3.0的轻度或弥散的FDG摄取部位视为阴性。根据改良的侵袭性淋巴瘤疗效评价标准(Cheson, J Clin Oncol, 2007)对临床分期和疗效进行评估。

结果：全组患者中位年龄57岁（23-82岁），38例（60.3%）为晚期患者，15例（23.8%）伴骨髓侵犯。组织学分型情况如下：外周T细胞淋巴瘤非特指型38.1%（24例），血管免疫母T细胞淋巴瘤12.7%（8例），淋巴结或结外的NK/T细胞34.9%（22例）以及其他亚型。诊断时，30例（47.6%）患者IPI评分为高危，29例（46%）PTCL预后指数（PIT）评分为高危（超过2个因素）。54例患者的中期疗效可评价，28例（44.4%）患者的中期PET/CT检查代谢摄取值仍为阳性。中期PET/CT检查阳性者的复发率较阴性者高（71.4% vs 38.5%，P=0.027)。中位随访12.2月（0.4-73月），中期PET/CT检查阳性是OS（ HR=3.79，1.66-8.65）和PFS （HR=3.19，1.48-6.89）的预后因素。中期PET/CT检查阳性组与阴性组的2年OS和PFS有显著差异，分别为25.6% vs 67.3%，22.3% vs 63.2%（P<0.01）。8例（12.7%）原先中期PET/CT检查结果阳性的患者通过局部活检证实为假阳性（阳性预测值0.83）。

结论：中期PET/CT检查结果对PTCL的疾病进展和生存具有显著的预测价值。中期PET/CT检查阳性的患者应考虑加强治疗强度，改变不良预后。

 

‘‘Focus on. . .’’ session: PET use in lymphoma 048 CLINICAL USEFULNESS AND PROGNOSTIC SIGNIFICANCE OF INTERIM 18F-FDG PET/CT FOR THE TREATMENT OF PERIPHERAL T CELL LYMPHOMAS

Although interim 18F-fluoro-2-dexoy-D-glucose-positron emission tomography (FDG-PET)/computerized tomography (CT) scan has emerged as a powerful prognostic tool in predicting treatment outcome in Hodgkin’s lymphoma (HL) and diffuse large B cell lymphoma (DLBCL), the prognostic value of interim PET/CT scanning has not been determined in patients with peripheral T cell lymphoma (PTCL). The sequential interim PET/CT was prospectively investigated to determine whether it provided additional prognostic information and could be a positive
predictable value for the treatment of PTCL.

Patients and Methods: Sixty-three patients with newly diagnosed PTCL were enrolled from Sep. 2005 to Feb. 2010 in a single institution. The PET/CT analysis was performed at the time of diagnosis, the mid-treatment and completion of CHOP/CHOP-like or other chemotherapy. Patients that had mild or diffuse FDG uptake at any site were considered negative for intensities lower than or equal to that of the mediastinal blood pool structures with SUV max cut-off value of 3.0. The clinical stage and response of the patients were assessed according to revised response criteria for aggressive lymphomas (Cheson, J Clin Oncol, 2007).

Results: Median age was 57 years (range: 23-82). 38 patients (60.3%) presented with advanced stage disease and 15 (23.8%) had bone marrow involvements. The histological subtypes were 38.1% PTCL-unspecified (n=24), 12.7% angioimmunoblastic T cell (n=8), 34.9% nodal or extranodal NK/T cell (n=22), and others. At diagnosis, 30 patients (47.6%) were classified as high-risk by the international prognostic index (IPI) and 29 (46%) were classified as high-risk (more than 2 factors) by the prognostic index for PTCL (PIT). 54 patients could be assessed the interim response and 28 patients (44.4%) remained positive metabolic uptakes in interim PET/CT. The patients with positive interim PET/CT showed a significantly higher relapse rate (71.4%) than those with negative interim PET/CT (38.5%) (P =0.027). After following median 12.2 months (range, 0.4-73), the positivity of interim PET/CT was significantly prognostic factor in both OS and PFS, with a hazard ratio of 3.79 (1.66 ? 8.65) and 3.19 (1.48 ? 6.89), respectively. The 2-year OS and PFS rate was significantly different in the patients with positive (22.3 and 25.6%) and negative (67.3 and 63.2%) interim PET/CT, respectively (P<0.01). Eight patients (12.7%) who determined to have positive interim PET/CT were revealed false-positive uptakes by locoregional biopsy (positive predictive value of 0.83).

Conclusions: Interim PET/CT has a significant predictive value for disease progression and survival of PTCL.The patients with positive interim PET/CT response should be considered an intensive therapeutic plan for overcoming their poor clinical outcome.