Nuclear Medicine Department, University Hospital S.Orsola-Malpighi Alma Mater Studiorum, Via Massarenti, 9, CAP 40138 Bologna, Italy.
Eur J Nucl Med Mol Imaging. 2012 May;39(5):864-71. doi: 10.1007/s00259-012-2079-y. Epub 2012 Feb 22.
We present findings concerning (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) at end-treatment evaluation in follicular lymphoma (FL) in order to establish possible predictive factors for progression-free survival (PFS) and patient outcome.
We retrospectively analysed data from 91 consecutive FL patients (M:F = 51:40, mean age 61) referred to our PET Unit at therapy completion: 38 with an indolent form (grade 1-2) and 53 with an aggressive FL (grade 3a and b) according to the World Health Organization (WHO) classification. A total of 148 FDG PET/CT scans were analysed and findings reported as positive or negative for disease. The overall response to treatment was assessed according to the revised International Workshop Criteria (IWC). The final outcome was defined as remission or disease by taking clinical, instrumental and histological data as standards of reference, with a mean follow-up period of 3 years (range 1-8). A statistical analysis was performed with respect to PFS and patient outcome for FDG PET result, tumour grading, Follicular Lymphoma International Prognostic Index (FLIPI), disease stage and number of relapses, on uni- and multivariate analyses, with p < 0.05 considered as significant.
Overall patients presented a mean PFS of 35 months (range 3-86), with a relapse rate of 42%. At final outcome, remission was achieved in 67 of 91 patients (74%). Of the different predictive factors, only FDG PET result significantly correlated with patient outcome (p = 0.0002). PET/CT performance at the end of treatment was as follows: 100% sensitivity, 99% specificity, 89% positive predictive value and 100% negative predictive value. The Kaplan-Meier analysis demonstrated a statistically significant correlation with PFS for FDG PET (p < 0.0001), FLIPI score (0-1 versus ≥ 2) (p = 0.0451) and number of relapses (none versus ≥ 1) (p = 0.0058). These findings were confirmed at the univariate analysis, whereas at the multivariate analysis only FDG PET (p = 0.0006892) and number of relapses (p = 0.01947) were independent predictive factors for PFS.
End-treatment PET/CT in FL has high accuracy and appears to be a good predictor of PFS and patient outcome, irrespective of grading. As expected, patients facing more than one relapse seem to have significantly shorter PFS in the presence of a positive FDG PET.
我们报告了滤泡性淋巴瘤（FL）治疗结束时（18）F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）的结果，旨在确定无进展生存期（PFS）和患者预后的可能预测因素。
我们回顾性分析了 91 例连续的 FL 患者（M：F=51：40，平均年龄 61 岁）在治疗完成时在我们的 PET 单位的数据：38 例为惰性形式（1-2 级），53 例为侵袭性 FL（3a 和 b 级）根据世界卫生组织（WHO）分类。共分析了 148 次 FDG PET/CT 扫描，并报告了疾病的阳性或阴性结果。根据修订的国际工作组标准（IWC）评估整体治疗反应。最终结果定义为缓解或疾病，以临床、仪器和组织学数据为参考标准，平均随访时间为 3 年（范围 1-8 年）。使用单变量和多变量分析，对 FDG PET 结果、肿瘤分级、滤泡性淋巴瘤国际预后指数（FLIPI）、疾病分期和复发次数与 PFS 和患者预后进行了统计学分析，p<0.05 被认为具有统计学意义。
总体而言，患者的平均 PFS 为 35 个月（范围 3-86），复发率为 42%。在最终结果中，91 例患者中有 67 例（74%）达到缓解。在不同的预测因素中，只有 FDG PET 结果与患者预后显著相关（p=0.0002）。治疗结束时 PET/CT 的表现如下：100%的灵敏度，99%的特异性，89%的阳性预测值和 100%的阴性预测值。Kaplan-Meier 分析显示，FDG PET（p<0.0001）、FLIPI 评分（0-1 与≥2）（p=0.0451）和复发次数（无与≥1）（p=0.0058）与 PFS 具有统计学显著相关性。这些发现在单变量分析中得到了证实，而在多变量分析中，只有 FDG PET（p=0.0006892）和复发次数（p=0.01947）是 PFS 的独立预测因素。
FL 治疗结束时的 PET/CT 具有很高的准确性，似乎是 PFS 和患者预后的良好预测指标，与分级无关。正如预期的那样，在存在阳性 FDG PET 的情况下，面临一次以上复发的患者的 PFS 明显缩短。
