Yang Deok-Hwan, Min Jung-Joon, Jeong Yong Yeon, Ahn Jae-Sook, Kim Yeo-Kyeoung, Cho Sang-Hee, Chung Ik-Joo, Bom Hee-Seung, Kim Hyeoung-Joon, Lee Je-Jung
Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea.
Ann Hematol. 2009 May;88(5):425-32. doi: 10.1007/s00277-008-0616-3. Epub 2008 Nov 12.
We investigated the concomitant interim response of patients with aggressive non-Hodgkin's lymphoma (NHL) using multi-detector row computerized tomography (CT) and (18)F-fluoro-2-deoxy-D: -glucose-positron emission tomography (PET)/CT for prediction of clinical outcomes. One hundred six newly diagnosed patients with aggressive NHL were enrolled. Both the CT and PET/CT were serially performed at the time of diagnosis and after three to four cycles of chemotherapy (interim). The patients were categorized into four different responsive groups according to the interim PET/CT and CT: (1) complete metabolic response (CMR)-complete response unconfirmed (CRu), (2) CMR-partial response (PR), (3) partial metabolic response (PMR)-Cru, and (4) PMR-PR. Fifty-five patients with CMR-CRu, 20 patients with CMR-PR, seven patients with PMR-Cru, and 23 patients with PMR-PR were distributed. In addition, one patient experienced a disease progression. There was a significant difference in relapse rates between PET/CT-positive (67.3%) and PET/CT-negative patients (17.3%; P < 0.01). Also, there was a significant difference between patients with PMR-PR (32.0% and 26.1%) and CMR-CRu (89.3% and 80.0%) for 3-year overall survival (OS) and event-free survival (EFS), respectively. A multivariate analysis revealed that high international prognostic index (> or =3) at diagnosis, T-cell phenotype, and PMR-PR in interim PET/CT and CT were independent prognostic significances for OS. Moreover, bulky disease (>10 cm), T-cell phenotype, and PMR-PR showed significant associations for EFS. PMR-PR in interim response was the predictive prognostic determinant for both OS and EFS, with a hazard ratio of 3.93 (1.61-9.60) and 3.60 (1.62-7.98), respectively. The combined evaluation of interim PET/CT and CT was found to be a significant predictor of disease progression, OS, and EFS.
我们使用多排螺旋计算机断层扫描（CT）和（18）F-氟-2-脱氧-D-葡萄糖-正电子发射断层扫描（PET）/CT研究侵袭性非霍奇金淋巴瘤（NHL）患者的同期中期反应，以预测临床结局。纳入106例新诊断的侵袭性NHL患者。在诊断时以及化疗三至四个周期后（中期）分别进行CT和PET/CT检查。根据中期PET/CT和CT将患者分为四个不同的反应组：（1）完全代谢缓解（CMR）-未确认的完全缓解（CRu），（2）CMR-部分缓解（PR），（3）部分代谢缓解（PMR）-Cru，（4）PMR-PR。分配了55例CMR-CRu患者、20例CMR-PR患者、7例PMR-Cru患者和23例PMR-PR患者。此外，1例患者疾病进展。PET/CT阳性患者（67.3%）和PET/CT阴性患者（17.3%；P<0.01）的复发率存在显著差异。同样，PMR-PR患者（32.0%和26.1%）与CMR-CRu患者（89.3%和80.0%）的3年总生存期（OS）和无事件生存期（EFS）分别存在显著差异。多因素分析显示，诊断时国际预后指数高（≥3）、T细胞表型以及中期PET/CT和CT中的PMR-PR对OS具有独立的预后意义。此外，大包块疾病（>10 cm）、T细胞表型和PMR-PR与EFS显著相关。中期反应中的PMR-PR是OS和EFS的预测性预后决定因素，风险比分别为3.93（1.61-9.60）和3.60（1.62-7.98）。发现中期PET/CT和CT的联合评估是疾病进展、OS和EFS的重要预测指标。
