PET/CT检查中骨髓FDG摄取模式对初诊弥漫性大B细胞淋巴瘤的预后价值
Prognostic Value of Bone Marrow FDG Uptake Pattern of PET/CT in Newly Diagnosed Diffuse Large B-cell Lymphoma.
作者信息
Chen Yumei, Zhou Mingge, Liu Jianjun, Huang Gang
机构信息
Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Cancer Metabolism, Institute of Health Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
J Cancer. 2018 Mar 14;9(7):1231-1238. doi: 10.7150/jca.23714. eCollection 2018.
The value of F-fluorodeoxyglucose positron emission tomography /computed tomography (F-FDG PET/CT) in assessing bone marrow involvement (BMI) of lymphoma remains controversial. The present study aims to evaluate the prognostic meaning of bone marrow FDG uptake pattern in PET/CT of newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients. 193 newly diagnosed DLBCL patients were retrospectively analyzed. All patients received 6-8 cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). The type of BM FDG uptake pattern was recorded by two blinded reviewers independently. The relationship between clinicopathologic features and BM patterns was analyzed. The prognostic value of different BM patterns was evaluated by Log-rank test and Cox-regression analysis. Out of 193 patients, 28 (15%) patients had focal BM FDG uptake higher than liver (fPET+), 18 (9%) patients showed diffuse BM uptake higher than liver (dPET+) and 147 (76%) patients had normal BM uptake (lower than liver) (nPET). BMB positive was found in 35.7% (10/28) of fPET+ patients, in 16.7% (3/18) of dPET+ patients and in 0.7% (1/147) of nPET patients. Diffuse BM pattern was associated with lower hemoglobin level and a trend of higher erythrocyte sedimentation rate (ESR). dPET+ patients had similar 3y-progression-free survival (3y-PFS) and 3y-overall survival (3y-OS) compared with nPET patients (80.5% vs 81.5%, p=0.701; 94.1% vs 90.6%, p=0.809, respectively), while fPET+ patients had worse 3y-PFS and 3y-OS compared with fPET- patients (32.7% vs 81.4%, p<0.001; 69.4% vs 90.9%, p=0.003, respectively). Multivariate analysis showed fPET+ (HR=2.270, p=0.025) and stage III/IV (HR=4.909, p=0.026) were independent predictors for PFS, but no factors were independently predictive for OS. PET/CT-directed BM patterns are meaningful in predicting prognosis of newly diagnosed DLBCL patients. Focal BM pattern is an independent predictor for PFS.
氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）在评估淋巴瘤骨髓受累（BMI）方面的价值仍存在争议。本研究旨在评估新诊断的弥漫性大B细胞淋巴瘤（DLBCL）患者PET/CT中骨髓FDG摄取模式的预后意义。对193例新诊断的DLBCL患者进行回顾性分析。所有患者均接受6-8个周期的利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）治疗。两名盲法阅片者独立记录骨髓FDG摄取模式的类型。分析临床病理特征与骨髓模式之间的关系。通过Log-rank检验和Cox回归分析评估不同骨髓模式的预后价值。在193例患者中，28例（15%）患者骨髓FDG局灶性摄取高于肝脏（fPET+），18例（9%）患者骨髓弥漫性摄取高于肝脏（dPET+），147例（76%）患者骨髓摄取正常（低于肝脏）（nPET）。fPET+患者中35.7%（10/28）骨髓活检阳性，dPET+患者中16.7%（3/18）阳性，nPET患者中0.7%（1/147）阳性。骨髓弥漫性模式与较低的血红蛋白水平以及较高的红细胞沉降率（ESR）趋势相关。dPET+患者与nPET患者的3年无进展生存率（3y-PFS）和3年总生存率（３y-OS）相似（分别为80.5%对81.5%，p=0.701；94.1%对90.6%，p=0.809），而fPET+患者与fPET-患者相比，3y-PFS和3y-OS更差（分别为32.7%对81.4%，p<0.001；69.4%对90.9%，p=0.003）。多因素分析显示fPET+（HR=2.270，p=0.025）和Ⅲ/Ⅳ期（HR=4.909，p=0.026）是PFS的独立预测因素，但没有因素是OS的独立预测因素。PET/CT指导的骨髓模式对预测新诊断的DLBCL患者的预后有意义。骨髓局灶性模式是PFS的独立预测因素。
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