弥漫性大 B 细胞淋巴瘤骨髓 2-[F]-氟-2-脱氧-d-葡萄糖摄取的预后意义：与髂嵴活检结果的关系。

Prognostic significance of bone marrow 2-[F]-fluoro-2-deoxy-d-glucose uptake in diffuse large B-cell lymphoma: relation to iliac crest biopsy results.

机构信息

Department of Nuclear Medicine, Soonchunhyang University Hospital, Seoul, South Korea.

Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.

出版信息

Clin Radiol. 2021 Jul;76(7):550.e19-550.e28. doi: 10.1016/j.crad.2021.02.023. Epub 2021 Mar 22.

DOI:10.1016/j.crad.2021.02.023

PMID:33762136

Abstract

AIM

To investigate the prognostic significance of bone marrow (BM) 2-[F]-fluoro-2-deoxy-d-glucose (FDG) uptake in relation to posterior iliac crest BM biopsy (BMB) results in diffuse large B-cell lymphoma (DLBCL).

MATERIALS AND METHODS

Pretreatment integrated positron-emission tomography(PET)/computed tomography (CT) images of 512 DLBCL patients who underwent BMB and received rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy were analysed retrospectively. BM uptake was assessed visually and by maximum standard uptake value (SUVmax). Associations with lymphoma-specific survival (LSS) were assessed using Kaplan-Meier and Cox regression analyses.

RESULTS

FDG(+) BM was observed in 64 cases (41 focal, 12 heterogeneous, 11 diffuse). This finding distinguished iliac crest involvement (positive in 59 and negative in 453) with 89.6% accuracy (459/512) and 93.6% specificity (424/453). In BMB(+) patients, BM-to-liver SUVmax ratio >1.8 concurred perfectly with FDG(+) BM. During 52 months of follow-up, there were 156 lymphoma-related deaths. In the entire population, multivariate analysis revealed high International Prognostic Index (IPI; p<0.001), old age (p=0.003), bulky disease (p=0.011), BMB(+) (p=0.028), and FDG(+) BM (p=0.019) as independent predictors of worse LSS. In the BMB(+) subgroup, high National Comprehensive Cancer Network-revised IPI (NCCN-IPI; p=0.029) and FDG(+) BM (p=0.008) were significant independent predictors. Among BMB(+) patients with low to low-intermediate NCCN-IPI, FDG(+) BM was associated with significantly worse 2-year LSS (33.3% versus 100%; p=0.017). The same was true among those with high-intermediate NCCN-IPI (34.7% versus 76.9%.; p=0.026).

CONCLUSION

Increased BM FDG in DLBCL is a predictor of worse LSS independent of BMB results and other prognostic variables including IPI/NCCN-IPI.

摘要

目的

探讨弥漫性大 B 细胞淋巴瘤（DLBCL）骨髓 2-[F]-氟-2-脱氧-D-葡萄糖（FDG）摄取与髂后嵴骨髓活检（BMB）结果的关系及其预后意义。

材料与方法

回顾性分析 512 例接受 BMB 和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）化疗的 DLBCL 患者的预处理整合正电子发射断层扫描（PET）/计算机断层扫描（CT）图像。通过目测和最大标准摄取值（SUVmax）评估骨髓摄取。采用 Kaplan-Meier 和 Cox 回归分析评估与淋巴瘤特异性生存（LSS）的相关性。

结果

64 例（41 例局灶性、12 例异质性、11 例弥漫性）患者出现 FDG（+）骨髓。该发现以 89.6%（459/512）的准确率和 93.6%（424/453）的特异性区分了髂嵴受累（阳性 59 例，阴性 453 例）。在 BMB（+）患者中，骨髓与肝脏 SUVmax 比值>1.8 与 FDG（+）骨髓完全一致。在 52 个月的随访期间，共有 156 例与淋巴瘤相关的死亡。在整个队列中，多变量分析显示国际预后指数（IPI；p<0.001）高、年龄较大（p=0.003）、肿块较大（p=0.011）、BMB（+）（p=0.028）和 FDG（+）骨髓（p=0.019）是 LSS 较差的独立预测因素。在 BMB（+）亚组中，高国家综合癌症网络修订的 IPI（NCCN-IPI；p=0.029）和 FDG（+）骨髓（p=0.008）是显著的独立预测因素。在低至低-中 NCCN-IPI 的 BMB（+）患者中，FDG（+）骨髓与显著较差的 2 年 LSS 相关（33.3%对 100%；p=0.017）。在高-中 NCCN-IPI 的患者中也存在同样的情况（34.7%对 76.9%；p=0.026）。