评估肿瘤大小缩小可改善晚期霍奇金淋巴瘤化疗后正电子发射断层扫描/计算机断层扫描的预后预测。
Assessment of tumor size reduction improves outcome prediction of positron emission tomography/computed tomography after chemotherapy in advanced-stage Hodgkin lymphoma.
机构信息
Carsten Kobe, Georg Kuhnert, Deniz Kahraman, Heinz Haverkamp, Hans-Theodor Eich, Mareike Franke, Thorsten Persigehl, David Maintz, Michael Fuchs, Peter Borchmann, Volker Diehl, Alexander Drzezga, Andreas Engert, and Markus Dietlein, University Hospital of Cologne, Cologne; Hans-Theodor Eich, University Hospital of Münster, Münster; Susanne Klutmann, University Medical Center Hamburg-Eppendorf, Hamburg; Holger Amthauer, Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; Andreas Bockisch, University of Duisburg-Essen, Duisburg and Essen; Regine Kluge, University of Leipzig, Leipzig; and Hans-Heinrich Wolf, Martin Luther University Halle-Wittenberg, Halle, Germany.
出版信息
J Clin Oncol. 2014 Jun 10;32(17):1776-81. doi: 10.1200/JCO.2013.53.2507. Epub 2014 May 5.
PURPOSE
Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT).
PATIENTS AND METHODS
The analysis set consisted of 739 patients with residues≥2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression.
RESULTS
In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P=.022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P=.9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%).
CONCLUSION
Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.
目的
化疗后正电子发射断层扫描（PET）可指导晚期霍奇金淋巴瘤（HL）的巩固性放疗。本分析旨在通过整合计算机断层扫描（CT）得出的其他标准来提高预后预测能力。
患者和方法
分析集包括来自德国霍奇金研究组（German Hodgkin Study Group）开展的 HD15 试验（HD15 治疗晚期霍奇金病：降低毒性的质量保证方案以及氟脱氧葡萄糖正电子发射断层扫描[FDG-PET]在晚期霍奇金病一线治疗中的预后相关性）的 2126 例患者中，739 例化疗后残留病灶≥2.5cm 的患者。一个中央小组对化疗前后的 CT 扫描和化疗后的 PET 扫描进行了图像分析和解释。采用无进展生存期（PFS）评估预后；使用对数秩检验比较各组。使用受试者工作特征（ROC）分析和逻辑回归分析调查潜在的预后因素。
结果
化疗后，739 例患者中共有 548 例（74%）PET 阴性残留病灶；这些患者未接受额外放疗，4 年 PFS 为 91.5%。191 例 PET 阳性（26%）接受额外放疗的患者 4 年 PFS 为 86.1%（P=.022）。单独使用 CT 并不能根据复发风险进一步区分部分缓解的患者（P=.9）。在 54 例 PET 阳性患者中，PET 阳性且肿瘤缩小程度小于 40%的亚组患者，在第 1 年内进展或复发的风险为 23.1%，而肿瘤缩小程度较大的患者的风险为 5.3%（差异为 17.9%；95%CI，5.8%至 30%）。
结论
化疗后 PET 阳性残留病灶且肿瘤缩小程度较差的 HL 患者进展或复发风险较高。
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