Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.
Hemato-Oncology Division, European Institute of Oncology, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
Eur Radiol. 2018 Mar;28(3):1187-1193. doi: 10.1007/s00330-017-5071-x. Epub 2017 Oct 10.
ᅟ: The indolent non-Hodgkin lymphomas (i-NHLs) are characterised by 'indolent' clinical behaviour with slow growth and prolonged natural history. The watchful waiting (WW) strategy is a frequently employed treatment option in these patients. This implies a strict monitoring by imaging examinations, including 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and CT. A major concern is radiation exposure due to regularly monitoring by conventional imaging procedures. Several studies have demonstrated the reliability of whole-body magnetic resonance imaging (WB-MRI) for lymphoma staging. WB-MRI could be useful for active surveillance in i-NHLs providing the suspect of disease progression that can be then confirmed by additional diagnostic procedures, including 18F-FDG-PET/CT. The directive 2013/59 by the European Union claims that if a radiation-free imaging technique allows obtaining the same diagnostic results, it should be invariably used. In this setting, WB-MRI may be considered a reasonable option in i-NHLs under WW, replacing imaging modalities that cause exposure to ionising radiations. This will help to reduce the cancer risk in i-NHL patients for whom chemo-/radiotherapy remain the usual treatment options following the usually long WW phase. The scientific community should raise the awareness of the risk of ionising radiations in i-NHLs and the emphasise the need for establishing the proper place of WB-MRI in lymphoma imaging.
• Watchful waiting is a reasonable option in patients with indolent non-Hodgkin lymphomas. • Imaging is crucial to monitor patients with indolent non-Hodgkin lymphomas. • CT and F-FDG-PET/CT are commonly used, implying a substantial radiation exposure. • WB-MRI is highly reliable in lymphoma staging. • WB-MRI may be considered to monitor indolent non-Hodgkin lymphomas under watchful waiting.
探讨惰性非霍奇金淋巴瘤（i-NHL）的临床特点及预后因素。方法：回顾性分析 2011 年 1 月至 2015 年 1 月于我院经病理证实的 231 例 i-NHL 患者的临床资料，采用 Kaplan-Meier 法进行生存分析，log-rank 检验进行单因素分析，Cox 比例风险回归模型进行多因素分析。结果：中位随访时间为 65 个月（2-144 个月），231 例患者中，Ⅰ/Ⅱ期 101 例（43.7%），Ⅲ/Ⅳ期 130 例（56.3%）；惰性 NHL 108 例（46.7%），侵袭性 NHL 123 例（53.3%）；中位无进展生存时间（PFS）为 57 个月（95%CI：46-68），中位总生存时间（OS）为 80 个月（95%CI：70-90）。单因素分析显示，Ann Arbor 分期、乳酸脱氢酶（LDH）、β2-微球蛋白（β2-MG）、国际预后指数（IPI）评分、结外侵犯部位、Ki-67 指数与 i-NHL 患者的 PFS 和 OS 相关（P<0.05）；多因素分析显示，Ann Arbor 分期、IPI 评分是影响 i-NHL 患者 PFS 的独立预后因素（P<0.05），Ann Arbor 分期、Ki-67 指数是影响 i-NHL 患者 OS 的独立预后因素（P<0.05）。结论：Ann Arbor 分期、IPI 评分、Ki-67 指数是影响 i-NHL 患者预后的独立因素，对于患者的治疗方案选择具有重要的指导意义。
