Milgrom Sarah A, Dong Wenli, Akhtari Mani, Smith Grace L, Pinnix Chelsea C, Mawlawi Osama, Rohren Eric, Garg Naveen, Chuang Hubert, Yehia Zeinab Abou, Reddy Jay P, Gunther Jillian R, Khoury Joseph D, Suki Tina, Osborne Eleanor M, Oki Yasuhiro, Fanale Michelle, Dabaja Bouthaina S
Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2017 Feb 1;97(2):333-338. doi: 10.1016/j.ijrobp.2016.10.029. Epub 2016 Oct 22.
In early-stage classical Hodgkin lymphoma, fluorodeoxyglucose positron emission tomography (PET)-computed tomography (CT) scans are performed routinely after chemotherapy, and the 5-point Deauville score is used to report the disease response. We hypothesized that other PET-CT parameters, considered in combination with Deauville score, would improve risk stratification.
Patients treated for stage I to II Hodgkin lymphoma from 2003 to 2013, who were aged ≥18 years and had analyzable PET-CT scans performed before and after chemotherapy, were eligible. The soft tissue volume (STV), maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis were recorded from the PET-CT scans before and after chemotherapy. Reductions were defined as 1 - (final PET-CT value)/(corresponding initial PET-CT value). The primary endpoint was freedom from progression (FFP).
For 202 patients treated with chemotherapy with or without radiation therapy, the 5-year FFP was 89% (95% confidence interval 85%-93%). All PET-CT parameters were strongly associated with the Deauville score (P<.001) and FFP (P<.0001) on univariate analysis. The Deauville score was highly predictive of FFP (C-index 0.89) but was less discriminating in the Deauville 1 to 4 subset (C-index 0.67). Therefore, we aimed to identify PET-CT parameters that would improve risk stratification for this subgroup (n=187). STV reduction was predictive of outcome (C-index 0.71) and was dichotomized with an optimal cutoff of 0.65 (65% reduction in STV). A model incorporating the Deauville score and STV reduction predicted FFP more accurately than either measurement alone in the Deauville 1 to 4 subset (C-index 0.83). The improvement in predictive accuracy of this composite measure compared with the Deauville score alone met statistical significance (P=.045).
The relative reduction in tumor size is an independent predictor of outcome. Combined with the Deauville score, it might improve risk stratification and contribute to response-adapted individualization of therapy.
在早期经典型霍奇金淋巴瘤中，化疗后常规进行氟脱氧葡萄糖正电子发射断层扫描（PET）-计算机断层扫描（CT），并使用5分的迪厄多内评分来报告疾病反应。我们假设，与迪厄多内评分相结合考虑的其他PET-CT参数将改善风险分层。
纳入2003年至2013年接受治疗的Ⅰ至Ⅱ期霍奇金淋巴瘤患者，年龄≥18岁，化疗前后有可分析的PET-CT扫描结果。从化疗前后的PET-CT扫描中记录软组织体积（STV）、最大标准化摄取值、代谢肿瘤体积和总病变糖酵解。减少率定义为1 - （最终PET-CT值）/（相应的初始PET-CT值）。主要终点是无进展生存期（FFP）。
对于202例接受化疗（有或无放射治疗）的患者，5年FFP为89%（95%置信区间85%-93%）。在单因素分析中，所有PET-CT参数均与迪厄多内评分（P<.001）和FFP（P<.0001）密切相关。迪厄多内评分对FFP具有高度预测性（C指数0.89），但在迪厄多内1至4亚组中鉴别能力较差（C指数0.67）。因此，我们旨在确定可改善该亚组（n=187）风险分层的PET-CT参数。STV减少率可预测预后（C指数0.71），并以0.65的最佳截断值进行二分法划分（STV减少65%）。在迪厄多内1至4亚组中，结合迪厄多内评分和STV减少率的模型比单独使用任何一种测量方法更准确地预测FFP（C指数0.83）。与单独的迪厄多内评分相比，这种综合测量方法在预测准确性上的提高具有统计学意义（P=.045）。
肿瘤大小的相对减少是预后的独立预测因素。与迪厄多内评分相结合，它可能改善风险分层，并有助于根据反应进行个体化治疗。
