Albano Domenico, Re Alessandro, Tucci Alessandra, Giubbini Raffaele, Bertagna Francesco
Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
Division of Hematology, Spedali Civili, Brescia, Italy.
Ann Nucl Med. 2019 Apr;33(4):280-287. doi: 10.1007/s12149-019-01338-9. Epub 2019 Feb 20.
Burkitt's lymphoma (BL) is an aggressive lymphoma sub-type with high 18F-FDG avidity, but no well established evidence of PET/CT's role in treatment evaluation or prognosis is currently available. The prognostic role of visual analysis and Deauville criteria for BL have already been demonstrated, while the potential usefulness of semi-quantitative PET/CT features remains unclear, especially the value of the rate of reduction in metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The aim of this retrospective study was to investigate whether ΔMTV and ΔTLG can predict treatment response at the end of therapy and prognosis in BL.
We retrospectively included 61 patients (mean age 61; 40 male, 21 female) who underwent baseline, interim and end-of-treatment 18F-FDG PET/CT. The PET/CT images were analyzed visually and semi-quantitatively by measuring total metabolic tumor volume (MTV) and total lesion glycolysis (TLG) for every scan. Then we calculated volume changes based on the percentage of MTV and TLG reduction between the baseline and interim PET (ΔMTVi and ΔTLGi) and between baseline and end-of-treatment PET/CT (ΔMTVeot and ΔTLGeot) and correlated them with clinical response and progression-free survival (PFS) and overall survival (OS). Survival curves were plotted according to the Kaplan-Meier method.
Forty patients had a complete response and 21 patients a partial response on interim 18F-FDG PET/CT. At end of treatment, 45 had a complete response, 11 partial response and 5 disease progression. At a median follow-up of 43 months, relapse/progression occurred in 18 patients and death in 11. ΔMTV and ΔTLG values were significantly higher in patients with complete response compared to no complete response. ΔMTVeot and ΔTLGeot were demonstrated to be independent prognostic factors for both PFS and OS, while ΔMTVi and ΔTLGi were not related to survival.
Metabolic tumor features (ΔMTV and ΔTLG) were significantly correlated with response to treatment and long-term outcome in BL.
伯基特淋巴瘤（BL）是一种侵袭性淋巴瘤亚型，具有较高的18F-FDG摄取，但目前尚无关于PET/CT在治疗评估或预后方面作用的确切证据。视觉分析和Deauville标准对BL的预后作用已得到证实，而半定量PET/CT特征的潜在效用仍不明确，尤其是代谢肿瘤体积（MTV）和总病变糖酵解（TLG）的降低率的价值。这项回顾性研究的目的是调查ΔMTV和ΔTLG是否能预测BL治疗结束时的治疗反应和预后。
我们回顾性纳入了61例患者（平均年龄61岁；男性40例，女性21例），这些患者接受了基线、中期和治疗结束时的18F-FDG PET/CT检查。通过测量每次扫描的总代谢肿瘤体积（MTV）和总病变糖酵解（TLG），对PET/CT图像进行视觉和半定量分析。然后我们根据基线和中期PET之间（ΔMTVi和ΔTLGi）以及基线和治疗结束时PET/CT之间（ΔMTVeot和ΔTLGeot）MTV和TLG降低的百分比计算体积变化，并将它们与临床反应、无进展生存期（PFS）和总生存期（OS）相关联。根据Kaplan-Meier方法绘制生存曲线。
40例患者在中期18F-FDG PET/CT检查时有完全缓解，21例患者有部分缓解。治疗结束时，45例完全缓解，11例部分缓解，5例疾病进展。中位随访43个月时，18例患者复发/进展，11例患者死亡。完全缓解患者的ΔMTV和ΔTLG值明显高于未完全缓解患者。ΔMTVeot和ΔTLGeot被证明是PFS和OS的独立预后因素，而ΔMTVi和ΔTLGi与生存无关。
代谢肿瘤特征（ΔMTV和ΔTLG）与BL的治疗反应和长期预后显著相关。
