Guevara David Ladrón de, Bernard Sebastián, Manhood Susana, Melani Sophia, Yerovi Fernando, Rodríguez María de Los Ángeles
Departamento de Radiología, Clínica Las Condes, Universidad de Chile, Santiago, Chile.
Alumno de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Rev Med Chil. 2020 Nov;148(11):1558-1567. doi: 10.4067/S0034-98872020001101558.
The prognosis of Non-Hodgkin Lymphoma (NHL) depends on the type of lymphoma, the extension of the disease and the response to therapy.
To evaluate the prognostic value of pretreatment and interim PET/CT compared to classic prognosis factors and body composition measurement (sarcopenia, adipopenia) in patients with recently diagnosed NHL.
Patients with recently diagnosed NHL who had staging 18F-FDG PET/CT performed between December 2008 and August 2018 were selected. Age, gender, weight, height, B symptoms, laboratory tests, pathology, staging PET/CT findings (Ann Arbor, number of nodal groups and extranodal sites involved, Bulky, maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis), Computed Tomography findings (psoas muscle mass index, psoas area, psoas density, subcutaneous fat index (all of them at L3 level), and Deauville score (Lugano Criteria) were recorded. The prognostic value of each of these factors was assessed using Cox multivariable regressions.
Of 138 NHL studied patients (median 61 y, 15-87 y, 60.4% men), 31 of them died due to the disease. The median follow-up was 39 months (1-115 months). The strongest prognostic factors were: B symptoms (p < 0.01), anemia (p < 0.01), hypoalbuminemia (p: 0.01), sarcopenia (p < 0.01), adipopenia (p < 0.01), number of node groups involved (p < 0.01), MTV (p < 0.01), and a bad response in interim PET/CT (p < 0.01). In a comparative Cox multivariable analysis, interim PET/CT was the independent variable with the highest significance (p < 0.01).
Early treatment response assessed by interim PET/CT is the strongest prognostic factor in NHL patients.
非霍奇金淋巴瘤（NHL）的预后取决于淋巴瘤的类型、疾病的分期以及对治疗的反应。
评估与经典预后因素和身体成分测量（肌肉减少症、脂肪减少症）相比，治疗前及中期PET/CT对新诊断的NHL患者的预后价值。
选取2008年12月至2018年8月期间进行分期18F-FDG PET/CT检查的新诊断NHL患者。记录年龄、性别、体重、身高、B症状、实验室检查、病理、分期PET/CT检查结果（Ann Arbor分期、受累淋巴结组数量和结外部位数量、大包块、最大标准化摄取值（SUVmax）、代谢肿瘤体积（MTV）和总病变糖酵解）、计算机断层扫描检查结果（腰大肌质量指数、腰大肌面积、腰大肌密度、皮下脂肪指数（均在L3水平）以及Deauville评分（卢加诺标准）。使用Cox多变量回归评估这些因素各自的预后价值。
在138例研究的NHL患者中（中位年龄61岁，15 - 87岁，60.4%为男性），其中31例死于该疾病。中位随访时间为39个月（1 - 115个月）。最强的预后因素为：B症状（p < 0.01）、贫血（p < 0.01）、低白蛋白血症（p: 0.01）、肌肉减少症（p < 0.01）、脂肪减少症（p < 0.01）、受累淋巴结组数量（p < 0.01）、MTV（p < 0.01）以及中期PET/CT检查结果不佳（p < 0.01）。在比较Cox多变量分析中，中期PET/CT是具有最高显著性的独立变量（p < 0.01）。
通过中期PET/CT评估的早期治疗反应是NHL患者最强的预后因素。
