Hématologie Clinique, CHU Le Bocage, Dijon, France; and.
J Nucl Med. 2014 Apr;55(4):569-73. doi: 10.2967/jnumed.113.130609. Epub 2014 Feb 24.
PET performed after 2 cycles of chemotherapy (PET2) allows prediction of outcome in most patients with Hodgkin lymphoma (HL). Visual analysis using a 5-point scale was proposed to assess PET response, but a semiquantitative approach using maximum standardized uptake value (SUVmax) reduction between baseline and interim PET was shown to be superior to the 5-point scale in patients with diffuse large B-cell lymphoma and may also improve the accuracy of interim PET interpretation in HL. To compare the clinical usefulness of both methods in HL patients, we analyzed PET2 according to visual and ΔSUVmax criteria in a retrospective single-center study.
From 2007 to 2010, 59 consecutive patients with a first diagnosis of HL were treated with 4-8 cycles of anthracycline-based chemotherapy. Radiotherapy was performed in 19 responding patients with localized disease. PET was done at baseline (PET0) and after 2 cycles of chemotherapy, and treatment was not modified according to the PET2 result. PET2 was interpreted using the 5-point scale (positivity for score 4 or 5). The SUVmax reduction between PET0 and PET2 (ΔSUVmax) was computed for all patients, and patients with a ΔSUVmax greater than 71% were considered good responders.
When the 5-point scale was used, 46 patients (78%) achieved a negative PET2 result, 7 of whom failed treatment (negative predictive value, 85%). Forty-nine patients (83%) had a ΔSUVmax greater than 71%, 6 of whom failed treatment (negative predictive value, 88%). The PET2 positive predictive value was significantly better for ΔSUVmax (70%) than for the 5-point scale (46%). When ΔSUVmax was used, 6 (46%) of the 13 PET2-positive patients could be reclassified as good responders. Although visual PET2 positivity was related to a lower 4-y progression-free survival (45%) compared with PET2 negativity (81%, P < 0.002), ΔSUVmax (>71 vs ≤71%) was more accurate for identifying patients with different 4-y progression-free survivals (82% vs. 30%; P < 0.0001). In multivariate analysis using the international prognosis score and ΔSUVmax as covariates, ΔSUVmax remained the unique independent predictor for progression-free survival (P = 0.0001; relative risk, 8.1).
Semiquantitative analysis was more accurate than visual analysis based on the 5-point scale to interpret PET2 and predict the outcome of HL patients. These encouraging results warrant further confirmation in larger and prospective series.
在大多数霍奇金淋巴瘤（HL）患者中，化疗 2 周期后行 PET（PET2）可预测结局。曾提出使用 5 分制视觉分析来评估 PET 反应，但使用基线和中期 PET 之间最大标准化摄取值（SUVmax）降低来进行半定量分析在弥漫性大 B 细胞淋巴瘤患者中显示优于 5 分制，并且可能也会提高 HL 中期 PET 解读的准确性。为了比较两种方法在 HL 患者中的临床应用价值，我们在回顾性单中心研究中根据视觉和 SUVmax 差值标准对 PET2 进行了分析。
2007 年至 2010 年，59 例初诊 HL 患者接受了 4-8 个周期基于蒽环类药物的化疗。19 例局部疾病有缓解的患者接受了放疗。在基线（PET0）和化疗 2 周期后行 PET，并且根据 PET2 结果不修改治疗。使用 5 分制（评分 4 或 5 表示阳性）对 PET2 进行解读。所有患者均计算了 PET0 与 PET2 之间的 SUVmax 降低值（ΔSUVmax），并且将 SUVmax 降低值大于 71%的患者视为良好应答者。
当使用 5 分制时，46 例（78%）患者获得阴性 PET2 结果，其中 7 例治疗失败（阴性预测值，85%）。49 例（83%）患者的 ΔSUVmax 大于 71%，其中 6 例治疗失败（阴性预测值，88%）。与 5 分制相比，ΔSUVmax 的 PET2 阳性预测值（70%）明显更好（46%）。当使用 ΔSUVmax 时，13 例 PET2 阳性患者中的 6 例（46%）可重新归类为良好应答者。尽管与 PET2 阴性相比，视觉 PET2 阳性与较低的 4 年无进展生存率（45%）相关（P < 0.002），但 ΔSUVmax（>71% vs ≤71%）对识别不同的 4 年无进展生存率患者更准确（82% vs. 30%；P < 0.0001）。在使用国际预后评分和 ΔSUVmax 作为协变量的多变量分析中，ΔSUVmax 仍然是无进展生存的唯一独立预测因素（P = 0.0001；相对危险度，8.1）。
与基于 5 分制的视觉分析相比，半定量分析更准确地解读了 PET2，并预测了 HL 患者的结局。这些令人鼓舞的结果需要在更大和前瞻性的系列中进一步证实。
