Wu Xingchen, Pertovaara Hannu, Korkola Pasi, Vornanen Martine, Järvenpää Ritva, Dastidar Prasun, Eskola Hannu, Kellokumpu-Lehtinen Pirkko-Liisa
Department of Oncology, Tampere University Hospital , Tampere , Finland.
Acta Oncol. 2014 Aug;53(8):1093-9. doi: 10.3109/0284186X.2014.927074. Epub 2014 Jun 24.
(18)F-FDG-PET/CT has been widely used in the staging of malignant lymphomas, and accepted as a tool for response assessment. Among PET parameters, the most frequently studied is maximal standardized uptake value (SUVmax). Metabolic tumor burden (MTB) is a parameter in which both metabolic tumor volume (MTV) and tumor activity are integrated. Here, we analyzed the prognostic value of SUVmax, SUVsum (sum of the SUVmax), whole-body MTV (MTVwb) and MTBwb from baseline and interim PET/CT in patients with diffuse large B-cell lymphoma (DLBCL).
Twenty-nine patients with histologically proven DLBCL were imaged by PET/CT before treatment (Exam I), and one week after the first dose of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) therapy (Exam II). Biopsy specimens were examined by an expert hematopathologist, the Ki-67 proliferation index (PI) was estimated for each biopsy site from the MIB-1 stained sections. The response evaluation was performed after chemotherapy completion (6-8 cycles).
All patients had one or more visualized lymphomatous lesions on (18)F-FDG-PET/CT. The SUVmax of the whole-body (BmSUVmax) was higher than the SUVmax at biopsy site (BxSUVmax) (mean: 20.1 vs. 17.3, p < 0.01). The PI correlated with the BxSUVmax (p < 0.05). One week after chemotherapy, SUVmax, SUVsum, MTVwb, and MTBwb decreased significantly (p < 0.01, respectively), SUVsum, MTVwb and MTBwb at Exam II correlated with chemotherapy response at treatment completion (p < 0.05, respectively).
SUVmax is more accurate to detect tumor aggressiveness than biopsy in DLBCL, since BmSUVmax represents the most aggressive tumor of the patient. Interim PET/CT as early as one week after R-CHOP therapy predicts response. Thus, it could be used as a tool for guidance of risk stratification in DLBCL.
（18）F-FDG-PET/CT已广泛应用于恶性淋巴瘤的分期，并被公认为是一种反应评估工具。在PET参数中，研究最频繁的是最大标准化摄取值（SUVmax）。代谢肿瘤负荷（MTB）是一个综合了代谢肿瘤体积（MTV）和肿瘤活性的参数。在此，我们分析了弥漫性大B细胞淋巴瘤（DLBCL）患者基线和中期PET/CT检查中SUVmax、SUV总和（SUVsum）、全身MTV（MTVwb）和MTBwb的预后价值。
29例经组织学证实的DLBCL患者在治疗前（检查I）以及在首次给予利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗一周后（检查II）接受PET/CT成像。活检标本由专业血液病理学家检查，从MIB-1染色切片中估计每个活检部位的Ki-67增殖指数（PI）。化疗完成后（6-8个周期）进行反应评估。
所有患者在（18）F-FDG-PET/CT上均有一个或多个可见的淋巴瘤病灶。全身SUVmax（BmSUVmax）高于活检部位的SUVmax（BxSUVmax）（平均值：20.1对17.3，p<0.01）。PI与BxSUVmax相关（p<0.05）。化疗一周后，SUVmax、SUVsum、MTVwb和MTBwb显著下降（分别为p<0.01），检查II时的SUVsum、MTVwb和MTBwb与治疗完成时的化疗反应相关（分别为p<0.05）。
在DLBCL中，SUVmax比活检更能准确检测肿瘤侵袭性，因为BmSUVmax代表患者最具侵袭性的肿瘤。R-CHOP治疗一周后尽早进行的中期PET/CT可预测反应。因此，它可作为DLBCL风险分层指导的工具。
