Department of Nuclear Medicine, Soonchunhyang University Hospital, Seoul, Korea.
Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul, 06351, Korea.
Sci Rep. 2021 Mar 15;11(1):5879. doi: 10.1038/s41598-021-85332-0.
Disseminated extranodal NK/T cell lymphoma (ENKTL) is associated with dismal prognosis. Hence, distinct tumor immune microenvironment (TIME) subtypes were proposed to explain their influence on ENKTL progression and help predict treatment response. In this study, we investigated the capacity of FDG PET/CT to discern ENKTL TIME subtypes. A total of 108 pretreatment FDG PET/CT scans of 103 patients with newly diagnosed or relapsed ENKTL were retrospectively analyzed. TIME subtype was determined using three key immunohistochemical markers. SUVmax, MTV and TLG were measured, and metabolic features associated with TIME subtype were statistically extracted. TIME subtype was immune tolerance (IT) in 13.9%, immune evasion A (IE-A) in 56.5%, immune evasion B (IE-B) in 21.3%, and immune silenced (IS) in 8%. The IS group showed the highest SUVmax (15.9 ± 6.4, P = 0.037), followed by IE-A (14.1 ± 7.8), IE-B (10.9 ± 5.6), and IT groups (9.6 ± 5.1). Among 53 with only nasal FDG lesions, 52 had non-IS subtype. Among 55 with extra-nasal FDG lesions, those with IS subtype more often had adrenal (P = 0.001) or testis involvement (P = 0.043), greater MTV (P = 0.005), greater TLG (P = 0.005), and SUVmax located at extra-nasal sites. The presence of 0-2 and 3-4 of these four findings was associated with low probability (2/46) and high probability (6/9) of IS subtype, respectively. Furthermore, patients showing IS subtype-favoring PET/CT pattern had worse overall survival compared to their counterparts. These results demonstrate that FDG PET/CT can help predict immune subtype in ENKTL patients. The different patterns between glycolytic activity and involved site according to TIME subtype might be related to the interplay between tumor cells and immune cells in the tumor microenvironment.
弥散性结外 NK/T 细胞淋巴瘤（ENKTL）预后不良。因此，提出了不同的肿瘤免疫微环境（TIME）亚型来解释它们对 ENKTL 进展的影响，并帮助预测治疗反应。在这项研究中，我们研究了 FDG PET/CT 区分 ENKTL TIME 亚型的能力。回顾性分析了 103 例新发或复发 ENKTL 患者的 108 例预处理 FDG PET/CT 扫描。使用三种关键的免疫组化标志物确定 TIME 亚型。测量 SUVmax、MTV 和 TLG，并提取与 TIME 亚型相关的代谢特征。TIME 亚型为免疫耐受（IT）13.9%，免疫逃逸 A（IE-A）56.5%，免疫逃逸 B（IE-B）21.3%，免疫沉默（IS）8%。IS 组 SUVmax 最高（15.9±6.4，P=0.037），其次是 IE-A（14.1±7.8）、IE-B（10.9±5.6）和 IT 组（9.6±5.1）。在 53 例仅鼻腔 FDG 病变中，52 例为非 IS 亚型。在 55 例鼻窦外 FDG 病变中，IS 亚型更常见肾上腺（P=0.001）或睾丸受累（P=0.043），更大 MTV（P=0.005），更大 TLG（P=0.005），以及位于鼻窦外的 SUVmax。这四个发现中 0-2 个和 3-4 个的存在与 IS 亚型的低概率（2/46）和高概率（6/9）相关。此外，表现出 IS 亚型有利的 PET/CT 模式的患者总生存时间比对照组差。这些结果表明 FDG PET/CT 可以帮助预测 ENKTL 患者的免疫亚型。根据 TIME 亚型，糖酵解活性和受累部位之间的不同模式可能与肿瘤微环境中肿瘤细胞和免疫细胞之间的相互作用有关。
