Kanoun Salim, Rossi Cédric, Berriolo-Riedinger Alina, Dygai-Cochet Inna, Cochet Alexandre, Humbert Olivier, Toubeau Michel, Ferrant Emmanuelle, Brunotte François, Casasnovas René-Olivier
Médecine nucléaire, Centre G.F. Leclerc, Dijon, France.
Eur J Nucl Med Mol Imaging. 2014 Sep;41(9):1735-43. doi: 10.1007/s00259-014-2783-x. Epub 2014 May 9.
The presence of a bulky tumour at staging in Hodgkin lymphoma (HL) is a predictor of a poor outcome. The total metabolic tumour volume at baseline (TMTV0) computed on PET may improve the evaluation of tumour burden. To explore the clinical usefulness of TMTV0, we compared the prognostic value of TMTV0, tumour bulk and interim PET response in a retrospective single-centre study.
From 2007 to 2010, 59 consecutive patients with a first diagnosis of HL were treated in our institution. PET was done at baseline (PET0) and after two cycles of chemotherapy (PET2), and treatment was not modified according to the PET2 result. TMTV0 was measured with a semiautomatic method using a 41 % SUVmax threshold. SUVmax reduction between PET0 and PET2 (ΔSUVmaxPET0-2) was also computed. Based on ROC analysis, patients with a ΔSUVmaxPET0-2 >71 % were considered good responders and a TMTV0 >225 ml was considered to represent hypermetabolic bulky disease.
Median TMTV0 was 117 ml and 17 patients (29 %) had a TMTV0 >225 ml. TMTV0 (>225 ml vs. ≤225 ml) and tumour bulk (<10 cm vs. ≥10 cm) were predictive of 4-year PFS: 42 % vs. 85 % (p = 0.001) and 44 % vs. 79 % (p < 0.03), respectively. In multivariate analysis, using ΔSUVmaxPET0-2, TMTV0 and bulky tumour as covariates, only ΔSUVmaxPET0-2 (p = 0.0005, RR 6.3) and TMTV0 (p < 0.006, RR 4.4) remained independent predictors of PFS. Three prognosis groups were thus identified: ΔSUVmaxPET0-2 >71 % and TMTV0 ≤225 ml (n = 37, 63 %), ΔSUVmaxPET0-2 = <71 % or TMTV0 >225 ml (n = 17, 29 %), and ΔSUVmaxPET0-2 = <71 % and TMTV0 >225 ml (n = 5, 8 %). In these three groups the 4-year PFS rates were 92 %, 49 %, and 20 % (p < 0.0001), respectively.
TMTV0 is more relevant than tumour bulk for predicting the outcome in patients with HL, and adds a significant prognostic insight to interim PET response assessment. The combination of TMTV0 and ΔSUVmaxPET0-2 made it possible to identify three subsets of HL patients with different outcomes. This may guide clinicians in their choice of therapeutic strategy.
霍奇金淋巴瘤（HL）分期时出现体积较大的肿瘤是预后不良的一个预测指标。基于PET计算的基线总代谢肿瘤体积（TMTV0）可能会改善对肿瘤负荷的评估。为了探究TMTV0的临床实用性，我们在一项回顾性单中心研究中比较了TMTV0、肿瘤体积和中期PET反应的预后价值。
2007年至2010年，我们机构连续治疗了59例初诊为HL的患者。在基线期（PET0）和化疗两个周期后（PET2）进行PET检查，且治疗方案不根据PET2结果进行调整。使用半自动方法以41%SUVmax阈值测量TMTV0。还计算了PET0和PET2之间的SUVmax降低值（ΔSUVmaxPET0 - 2）。基于ROC分析，ΔSUVmaxPET0 - 2>71%的患者被认为是良好反应者，TMTV0>225 ml被认为代表高代谢大体积疾病。
TMTV0中位数为117 ml，17例患者（29%）的TMTV0>225 ml。TMTV0（>225 ml与≤225 ml）和肿瘤体积（<10 cm与≥10 cm）可预测4年无进展生存期（PFS）：分别为42%对85%（p = 0.001）和44%对79%（p < 0.03）。在多变量分析中，将ΔSUVmaxPET0 - 2、TMTV0和大体积肿瘤作为协变量，只有ΔSUVmaxPET0 - 2（p = 0.0005，RR 6.3）和TMTV0（p < 0.006，RR 4.4）仍然是PFS的独立预测因素。因此确定了三个预后组：ΔSUVmaxPET0 - 2>71%且TMTV0≤225 ml（n = 37，63%），ΔSUVmaxPET0 - 2<71%或TMTV0>225 ml（n = 17，29%），以及ΔSUVmaxPET0 - 2<71%且TMTV0>225 ml（n = 5，8%）。在这三组中，4年PFS率分别为92%、49%和20%（p < 0.0001）。
对于预测HL患者的预后，TMTV0比肿瘤体积更具相关性，并且为中期PET反应评估增加了重要的预后见解。TMTV0和ΔSUVmaxPET0 - 2的联合使用能够识别出具有不同预后的三组HL患者。这可能会指导临床医生选择治疗策略。
