Zhang Y, Zhou J, Wang L, Li J Y, Ding C Y
Department of Radiology, Shuyang Traditional Chinese Medicine Hospital, Suqian 223600, China.
Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210009, China.
Zhonghua Zhong Liu Za Zhi. 2020 Oct 23;42(10):885-890. doi: 10.3760/cma.j.cn112152-20191115-00739.
To investigate the prognostic value of bone marrow (BM) (18)F-fluorodeoxyglucose ((18)F-FDG) uptake pattern of pretreatment positron emission tomography/computed tomography (PET-CT) in extranodal NK/T cell lymphoma (ENKTL) patients. We retrospectively collected clinical data from a series of 63 ENKTL patients with stageⅡ~Ⅳ, who have received both (18)F-FDG PET-CT and bone marrow biopsy (BMB) prior to treatment. According the BM (18)F-FDG uptake pattern of PET-CT, the patients were divided into three groups: focal BM FDG uptake higher than liver (fPET+ ), diffuse BM uptake higher than liver (dPET+ ) and normal BM uptake (lower than liver) (nPET). The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis, and COX proportional hazards model for multivariate analysis. Among the 63 patients, 22 patients had nPET, 24 patients showed dPET+ , and 17 patients had fPET+ . BMB positive was found in 8 patients, and negative in 55 patients. Thirty-seven patients had disease progression or relapse, and 31 patients died. The 3-years progression free survival (3y-PFS) rates of fPET+ patients and nPET patients were 14.7% and 63.6% (=0.006). The 3-years overall survival (3y-OS) rates were 18.8% and 64.8% (=0.005). The 3y-PFS of dPET+ patients and nPET patients were 35.6% and 63.6% (=0.161), 3y-OS were 47.9% and 64.8% (=0.280). Univariate analysis showed that lactate dehydrogenase (LDH) level, Epstein-Barr virus DNA (EBV-DNA), Korean prognostic index (KPI) and BM (18)F-FDG were related with PFS and OS (all <0.05). Multivariate analysis showed EBV-DNA and BM (18)F-FDG were independent predictors for PFS (<0.05). EBV-DNA was also an independently predictor for OS (<0.05). PET/CT-directed BM patterns are meaningful in predicting prognosis of newly diagnosed ENKTL patients. Focal BM (18)F-FDG uptake pattern is an independent predictor for PFS.
探讨初治正电子发射断层扫描/计算机断层扫描（PET-CT）骨髓（BM）（18）F-氟脱氧葡萄糖（（18）F-FDG）摄取模式在结外NK/T细胞淋巴瘤（ENKTL）患者中的预后价值。我们回顾性收集了63例Ⅱ~Ⅳ期ENKTL患者的临床资料，这些患者在治疗前均接受了（18）F-FDG PET-CT及骨髓活检（BMB）。根据PET-CT的BM（18）F-FDG摄取模式，将患者分为三组：局部BM FDG摄取高于肝脏（fPET+）、弥漫性BM摄取高于肝脏（dPET+）和正常BM摄取（低于肝脏）（nPET）。采用Kaplan-Meier法和Log-rank检验分别进行生存分析和单因素分析，采用COX比例风险模型进行多因素分析。63例患者中，22例为nPET，24例为dPET+，17例为fPET+。BMB阳性8例，阴性55例。37例患者疾病进展或复发，31例患者死亡。fPET+组和nPET组患者的3年无进展生存率（3y-PFS）分别为14.7%和63.6%（P=0.006）。3年总生存率（3y-OS）分别为18.8%和64.8%（P=0.005）。dPET+组和nPET组患者的3y-PFS分别为35.6%和63.6%（P=0.161），3y-OS分别为47.9%和64.8%（P=0.280）。单因素分析显示，乳酸脱氢酶（LDH）水平、爱泼斯坦-巴尔病毒DNA（EBV-DNA）、韩国预后指数（KPI）及BM（18）F-FDG与PFS和OS相关（均P<0.05）。多因素分析显示，EBV-DNA及BM（18）F-FDG是PFS的独立预测因素（P<0.05）。EBV-DNA也是OS的独立预测因素（P<0.05）。PET/CT引导的BM模式对预测新诊断ENKTL患者的预后具有重要意义。局部BM（18）F-FDG摄取模式是PFS的独立预测因素。
