Kim Jihyun, Lee Jeong-Ok, Paik Jin Ho, Lee Won Woo, Kim Sang Eun, Song Yoo Sung
Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
Ann Nucl Med. 2017 Jan;31(1):1-11. doi: 10.1007/s12149-016-1123-6. Epub 2016 Sep 15.
Diffuse large B-cell lymphoma (DLBCL) is a pathologically heterogeneous disease with different prognoses according to its molecular profiles. Despite the broad usage of F-fluoro-2-dexoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT), previous studies that have investigated the value of interim F-FDG PET/CT in DLBCL have given the controversial results. The purpose of this study was to evaluate the prognostic value of interim F-FDG PET/CT in DLBCL according to germinal center B cell-like (GCB) and non-GCB molecular profiling.
We enrolled 118 newly diagnosed DLBCL patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Interim F-FDG PET/CT scans performed after 2 or 3 cycles of R-CHOP treatment were evaluated based on the Lugano response criteria. Patients were grouped as GCB or non-GCB molecular subtypes according to immunohistochemistry results of CD10, BCL6, and MUM1, based on Hans' algorithm.
In total 118 DLBCL patients, 35 % were classified as GCB, and 65 % were classified as non-GCB. Interim PET/CT was negative in 70 %, and positive in 30 %. During the median follow-up period of 23 months, the positive interim F-FDG PET/CT group showed significantly inferior progression free survival (PFS) compared to the negative interim F-FDG PET/CT group (P = 0.0004) in entire patients. A subgroup analysis according to molecular profiling demonstrated significant difference of PFS between the positive and negative interim F-FDG PET groups in GCB subtype of DLBCL (P = 0.0001), but there was no significant difference of PFS between the positive and negative interim F-FDG PET groups in non-GCB subtype of DLBCL.
Interim F-FDG PET/CT scanning had a significant predictive value for disease progression in patients with the GCB subtype of DLBCL treated with R-CHOP, but not in those with the non-GCB subtype. Therefore, molecular profiles of DLBCL should be considered for interim F-FDG PET/CT practice.
弥漫性大B细胞淋巴瘤（DLBCL）是一种病理异质性疾病，根据其分子特征具有不同的预后。尽管氟代脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）已被广泛应用，但先前研究DLBCL中中期FDG PET/CT价值的结果存在争议。本研究旨在根据生发中心B细胞样（GCB）和非GCB分子特征评估中期FDG PET/CT在DLBCL中的预后价值。
我们纳入了118例接受利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗的新诊断DLBCL患者。根据卢加诺反应标准评估在R-CHOP治疗2或3个周期后进行的中期FDG PET/CT扫描。根据基于汉斯算法的CD10、BCL6和MUM1免疫组化结果，将患者分为GCB或非GCB分子亚型。
在总共118例DLBCL患者中，35%被分类为GCB，65%被分类为非GCB。中期PET/CT阴性者占70%，阳性者占30%。在23个月的中位随访期内，整个患者中，中期FDG PET/CT阳性组的无进展生存期（PFS）明显低于中期FDG PET/CT阴性组（P = 0.0004）。根据分子特征进行的亚组分析显示，DLBCL的GCB亚型中，中期FDG PET阳性和阴性组之间的PFS存在显著差异（P = 0.0001），但在DLBCL的非GCB亚型中，中期FDG PET阳性和阴性组之间的PFS没有显著差异。
中期FDG PET/CT扫描对接受R-CHOP治疗的DLBCL的GCB亚型患者的疾病进展具有显著预测价值，但对非GCB亚型患者则不然。因此，在进行中期FDG PET/CT检查时应考虑DLBCL的分子特征。
