Jerusalem G, Beguin Y, Fassotte M F, Najjar F, Paulus P, Rigo P, Fillet G
Department of Medicine, Division of Onco-Hematology, University of Liège, Liège, Belgium.
Haematologica. 2000 Jun;85(6):613-8.
Early recognition of the ineffectiveness of chemotherapy could result in lower cumulative drug toxicity and tumor burden at the start of salvage therapy, which might improve clinical outcome. Therefore, we studied the value of (18)F-FDG PET for early evaluation of response in patients with non-Hodgkin's lymphoma (NHL).
We studied 28 patients by (18)F-FDG PET after a median of 3 cycles of polychemotherapy. The presence or absence of abnormal (18)F-FDG uptake was correlated to clinical outcome (median follow-up: 17.5 months, range 4-47 months).
Five of 28 patients still had increased (18)F-FDG uptake in one or more sites previously shown to be involved by lymphoma at baseline evaluation. Only one of these five patients entered complete remission (CR), whereas among the 23 patients with negative (18)F-FDG PET studies, two died of toxicity during chemotherapy and all the others entered clinical CR (p<0.00001). All five patients with and 7/21 patients without residual abnormal (18)F-FDG uptake relapsed or reprogressed (positive predictive value for relapse: 100%, negative predictive value: 67%). By Kaplan-Meier analysis, progression-free survival (PFS) at 1 and 2 years was respectively 20+/-18% and 0% for (18)F-FDG PET positive patients and 81+/-9% and 62+/-12% for (18)F-FDG PET negative patients (p=0.0001). Overall survival (OS) at 1 and 2 years was respectively 20+/-18% and 0% for (18)F-FDG PET positive and 87+/-7% and 68+/-11% for (18)F-FDG PET negative patients (p<0.0001).
Persistent tumoral (18)F-FDG uptake after a few cycles of polychemotherapy is predictive of CR, PFS and OS in NHL. Further studies are warranted to determine whether (18)F-FDG PET has a predictive value independent from conventional prognostic factors. However, the sensitivity of qualitative (18)F-FDG PET imaging in identifying patients with a poor outcome was insufficient. Earlier evaluation after only one cycle of chemotherapy and quantitative analysis might increase the sensitivity of 18F-FDG PET is predicting treatment failure.
早期识别化疗无效可降低挽救治疗开始时的累积药物毒性和肿瘤负荷，这可能改善临床结局。因此，我们研究了¹⁸F-FDG PET在非霍奇金淋巴瘤（NHL）患者早期疗效评估中的价值。
我们对28例患者在接受中位3个周期的联合化疗后进行了¹⁸F-FDG PET检查。¹⁸F-FDG摄取异常的有无与临床结局相关（中位随访时间：17.5个月，范围4 - 47个月）。
28例患者中有5例在基线评估时曾显示淋巴瘤累及的一个或多个部位仍有¹⁸F-FDG摄取增加。这5例患者中只有1例进入完全缓解（CR），而在¹⁸F-FDG PET检查为阴性的23例患者中，2例在化疗期间死于毒性反应，其他所有患者均进入临床CR（p<0.00001）。5例¹⁸F-FDG摄取仍异常的患者和21例¹⁸F-FDG摄取无残留异常的患者中有7例复发或病情进展（复发的阳性预测值：100%，阴性预测值：67%）。通过Kaplan-Meier分析，¹⁸F-FDG PET阳性患者1年和2年的无进展生存期（PFS）分别为20±18%和0%，¹⁸F-FDG PET阴性患者分别为81±9%和62±12%（p = 0.0001）。¹⁸F-FDG PET阳性患者1年和2年的总生存期（OS）分别为20±18%和0%，¹⁸F-FDG PET阴性患者分别为87±7%和68±11%（p<0.0001）。
几个周期的联合化疗后肿瘤持续¹⁸F-FDG摄取可预测NHL患者的CR、PFS和OS。有必要进一步研究以确定¹⁸F-FDG PET是否具有独立于传统预后因素的预测价值。然而，定性¹⁸F-FDG PET成像在识别预后不良患者方面的敏感性不足。仅在一个周期化疗后进行更早的评估和定量分析可能会提高¹⁸F-FDG PET预测治疗失败的敏感性。
