Department of Nuclear Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France.
Santa Maria Nuova Hospital-IRCCS Reggio Emilia, Reggio Emilia, Italy.
Blood. 2018 Mar 29;131(13):1456-1463. doi: 10.1182/blood-2017-07-795476. Epub 2018 Feb 1.
We tested baseline positron emission tomography (PET)/computed tomography (CT) as a measure of total tumor burden to better identify high-risk patients with early-stage Hodgkin lymphoma (HL). Patients with stage I-II HL enrolled in the standard arm (combined modality treatment) of the H10 trial (NCT00433433) with available baseline PET and interim PET (iPET2) after 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine were included. Total metabolic tumor volume (TMTV) was measured on baseline PET. iPET2 findings were reported negative (DS1-3) or positive (DS4-5) with the Deauville scale (DS). The prognostic value of TMTV was evaluated and compared with baseline characteristics, staging classifications, and iPET2. A total of 258 patients were eligible: 101 favorable and 157 unfavorable. The median follow-up was 55 months, with 27 progression-free survival (PFS) and 12 overall survival (OS) events. TMTV was a prognosticator of PFS ( < .0001) and OS ( = .0001), with 86% and 84% specificity, respectively. Five-year PFS and OS were 71% and 83% in the high-TMTV (>147 cm) group (n = 46), respectively, vs 92% and 98% in the low-TMTV group (≤147 cm). In multivariable analysis including iPET2, TMTV was the only baseline prognosticator compared with the current staging systems proposed by the European Organization for Research and Treatment of Cancer/Groupe d'Etude des Lymphomes de l'Adulte, German Hodgkin Study Group, or National Comprehensive Cancer Network. TMTV and iPET2 were independently prognostic and, combined, identified 4 risk groups: low (TMTV≤147+DS1-3; 5-year PFS, 95%), low-intermediate (TMTV>147+DS1-3; 5-year PFS, 81.6%), high-intermediate (TMTV≤147+DS4-5; 5-year PFS, 50%), and high (TMTV>147+DS4-5; 5-year PFS, 25%). TMTV improves baseline risk stratification of patients with early-stage HL compared with current staging systems and the predictive value of early PET response as well.
我们测试了基线正电子发射断层扫描（PET）/计算机断层扫描（CT）作为总肿瘤负担的衡量标准，以更好地识别早期霍奇金淋巴瘤（HL）的高危患者。在 H10 试验（NCT00433433）的标准臂（联合治疗）中招募了 I 期-II 期 HL 患者，这些患者在接受阿霉素、博来霉素、长春碱和达卡巴嗪 2 个周期后接受了基线 PET 和中期 PET（iPET2）检查。基线 PET 上测量了总代谢肿瘤体积（TMTV）。iPET2 结果用 Deauville 评分（DS）报告为阴性（DS1-3）或阳性（DS4-5）。评估了 TMTV 的预后价值，并与基线特征、分期分类和 iPET2 进行了比较。共有 258 名患者符合条件：101 例预后良好，157 例预后不良。中位随访时间为 55 个月，有 27 例无进展生存期（PFS）和 12 例总生存期（OS）事件。TMTV 是 PFS（<0.0001）和 OS（=0.0001）的预后因素，特异性分别为 86%和 84%。高 TMTV（>147cm）组（n=46）的 5 年 PFS 和 OS 分别为 71%和 83%，而低 TMTV 组（≤147cm）的 5 年 PFS 和 OS 分别为 92%和 98%。在包括 iPET2 的多变量分析中，与欧洲癌症研究与治疗组织/成人淋巴瘤研究组、德国霍奇金研究组或国家综合癌症网络提出的当前分期系统相比，TMTV 是唯一的基线预后因素。TMTV 和 iPET2 都是独立的预后因素，两者结合可确定 4 个风险组：低风险（TMTV≤147+DS1-3；5 年 PFS，95%）、低中风险（TMTV>147+DS1-3；5 年 PFS，81.6%）、中高风险（TMTV≤147+DS4-5；5 年 PFS，50%）和高风险（TMTV>147+DS4-5；5 年 PFS，25%）。与当前的分期系统和早期 PET 反应的预测价值相比，TMTV 可改善早期 HL 患者的基线风险分层。
