移植前和移植后F-氟脱氧葡萄糖正电子发射断层扫描结果在接受自体干细胞移植的非霍奇金淋巴瘤患者中的预后价值
Prognostic value of pre- and post-transplantation F-fluorodeoxyglucose positron emission tomography results in non-Hodgkin lymphoma patients receiving autologous stem cell transplantation.
作者信息
Ying Zhitao, Mi Lan, Wang Xuejuan, Zhang Yuewei, Yang Zhi, Song Yuqin, Wang Xiaopei, Zheng Wen, Lin Ningjing, Tu Meifeng, Xie Yan, Ping Lingyan, Zhang Chen, Liu Weiping, Deng Lijuan, Zhu Jun
机构信息
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China.
出版信息
Chin J Cancer Res. 2017 Dec;29(6):561-571. doi: 10.21147/j.issn.1000-9604.2017.06.11.
OBJECTIVE
High-dose chemotherapy (HDC) followed by autologous stem cell transplantation (ASCT) is the standard of care in the upfront or relapsed/refractory setting in some patients with non-Hodgkin lymphoma (NHL). However, a proportion of patients do not respond to ASCT. F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) has been widely used for staging, response evaluation, and prognosis prediction. Here, we investigated the prognostic role of PET/CT in NHL patients before and after ASCT.
METHODS
A retrospective study was conducted at Peking University Cancer Hospital. All NHL patients who underwent ASCT between March 2010 and July 2016 were identified. Patients who had PET/CT scan before and after ASCT were included. Deauville criteria (5-point scale) were used to interpret PET scans. Univariate and multivariate survival analyses were performed using Cox regression. The predictive value of PET scanning was estimated by comparing the area under the receiver operating characteristic (ROC) curve.
RESULTS
In total, 79 patients were enrolled in this study. In univariate analysis, pre- and post-ASCT PET result was identified as prognostic factors for 3-year progression-free survival (PFS) and overall survival (OS). Patients with negative pre-ASCT PET result demonstrated significantly better PFS (84.2% . 54.2%) and OS (89.2% . 63.6%) than patients with positive pre-ASCT PET result. PFS (91.6% . 25.3%) and OS (96.5% . 36.8%) were also significantly different between patients with negative and positive post-ASCT PET result. Multivariate analysis also showed a significant association between survival and post-ASCT PET result. ROC analysis revealed that the predictive value of post-ASCT PET result was superior to that of pre-ASCT PET result alone. Combined pre- and post-ASCT PET result is better for predicting outcomes in patients with NHL receiving transplantation. Deauville criteria score >3 was identified as the best cutoff value for post-ASCT PET.
CONCLUSIONS
Post-ASCT PET result was more important than pre-ASCT PET result in predicting outcomes for NHL patients who underwent ASCT. The prognostic significance can be improved when combining pre-ASCT PET result with post-ASCT PET result. Deauville criteria can be used for interpreting PET scans in this scenario.
目的
大剂量化疗（HDC）后行自体干细胞移植（ASCT）是部分非霍奇金淋巴瘤（NHL）患者初始治疗或复发/难治性情况下的标准治疗方案。然而，一部分患者对ASCT无反应。F - 氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）已广泛用于分期、疗效评估和预后预测。在此，我们研究了PET/CT在NHL患者ASCT前后的预后作用。
方法
在北京大学肿瘤医院进行了一项回顾性研究。确定了2010年3月至2016年7月期间接受ASCT的所有NHL患者。纳入在ASCT前后进行了PET/CT扫描的患者。采用Deauville标准（5分制）解读PET扫描结果。使用Cox回归进行单因素和多因素生存分析。通过比较受试者工作特征（ROC）曲线下面积评估PET扫描的预测价值。
结果
本研究共纳入79例患者。在单因素分析中，ASCT前后的PET结果被确定为3年无进展生存期（PFS）和总生存期（OS）的预后因素。ASCT前PET结果为阴性的患者的PFS（84.2%对54.2%）和OS（89.2%对63.6%）显著优于ASCT前PET结果为阳性的患者。ASCT后PET结果为阴性和阳性的患者之间的PFS（91.6%对25.3%）和OS（96.5%对36.8%）也有显著差异。多因素分析还显示生存与ASCT后PET结果之间存在显著关联。ROC分析显示，ASCT后PET结果的预测价值优于单独的ASCT前PET结果。联合ASCT前后的PET结果对接受移植的NHL患者的预后预测更好。Deauville标准评分>3被确定为ASCT后PET的最佳临界值。
结论
在预测接受ASCT的NHL患者的预后时，ASCT后的PET结果比ASCT前的PET结果更重要。将ASCT前PET结果与ASCT后PET结果相结合可提高预后意义。在此情况下，Deauville标准可用于解读PET扫描结果。
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