Qiao Wenli, Zhao Jinhua, Wang Chun, Wang Taisong, Xing Yan
Department of Nuclear Medicine, The First People's Hospital, Shanghai Jiaotong University, China.
Hematology. 2010 Feb;15(1):21-7. doi: 10.1179/102453310X12583347009739.
Evaluation of therapeutic response in non-Hodgkin's lymphoma (NHL) patients with autologous stem cell transplantation (ASCT) is of great clinical significance. But the exact role of (18)F-fluorodeoxyglucose (FDG) imaging in NHL associated with ASCT is unclear. This study assessed the predictive value of (18)F-FDG hybrid PET/CT imaging for the clinical outcome such as progression-free survival (PFS) in patients with NHL prior to and after ASCT.
(18)F-FDG hybrid PET/CT was performed in 31 patients (24 male and 7 female) with pathologically confirmed NHL prior to and after ASCT. Mean age was 43.1+/-13.8 years. No patients were lost to follow-up earlier than 1 year from ASCT. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of (18)F-FDG hybrid PET/CT before ASCT were compared to the results after ASCT. The results of pre- and post-ASCT FDG hybrid PET/CT findings were correlated to PFS using Kaplan-Meier survival analysis. Regression analyses were employed to test for independence of established prognostic factors.
Sixteen of 31 patients (52%) progressed/relapsed or died after a median follow-up of 7 months, the remaining 15 patients (48%) were disease free after a median follow-up of 24 months. Both pre- and post-ASCT, (18)F-FDG hybrid PET/CT findings showed high PPV, NPV and accuracy (85.7 versus 92.3%, 76.5 versus 77.8% and 80.6 versus 83.9%). Both pre- and post-ASCT, (18)F-FDG hybrid PET/CT findings were strongly correlated with PFS (P<0.0005, significant). Of pre- ASCT FDG finding, the 1-year PFS rate for FDG-negative and FDG-positive patients was 88.2 and 28.6%. Of post-ASCT FDG finding, the 1-year PFS rate for FDG-negative patients and FDG-positive patients was 88.9 and 23.1%. The regression model showed that the predictive value of FDG imaging owed its significance to the very high hazard ratio between patients with positive FDG imaging and negative FDG imaging (P<0.005) both pre- and post-ASCT.
(18)F-FDG hybrid PET/CT imaging prior to and following autologous stem cell transplantation in NHL contains predictive information on the long-term clinical outcome.
评估非霍奇金淋巴瘤（NHL）患者自体干细胞移植（ASCT）后的治疗反应具有重要的临床意义。但（18）F-氟脱氧葡萄糖（FDG）成像在与ASCT相关的NHL中的确切作用尚不清楚。本研究评估了（18）F-FDG 杂交PET/CT成像对NHL患者ASCT前后无进展生存期（PFS）等临床结局的预测价值。
对31例（24例男性和7例女性）经病理证实的NHL患者在ASCT前后进行了（18）F-FDG杂交PET/CT检查。平均年龄为43.1±13.8岁。没有患者在ASCT后1年内失访。将ASCT前（18）F-FDG杂交PET/CT的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性与ASCT后的结果进行比较。采用Kaplan-Meier生存分析将ASCT前后FDG杂交PET/CT检查结果与PFS进行相关性分析。采用回归分析检验既定预后因素的独立性。
31例患者中有16例（52%）在中位随访7个月后进展/复发或死亡，其余15例患者（48%）在中位随访24个月后无疾病。ASCT前后，（18）F-FDG杂交PET/CT检查结果均显示出较高的PPV、NPV和准确性（分别为85.7%对92.3%、76.5%对77.8%、80.6%对83.9%）。ASCT前后，（18）F-FDG杂交PET/CT检查结果均与PFS密切相关（P<0.0005，具有显著性）。对于ASCT前的FDG检查结果，FDG阴性和阳性患者的1年PFS率分别为88.2%和28.6%。对于ASCT后的FDG检查结果，FDG阴性和阳性患者的1年PFS率分别为88.9%和23.1%。回归模型显示，FDG成像的预测价值归因于FDG成像阳性和阴性患者之间极高的风险比（P<0.005），无论是在ASCT前还是ASCT后。
NHL患者自体干细胞移植前后的（18）F-FDG杂交PET/CT成像包含有关长期临床结局的预测信息。
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