氟代胸苷 PET 是弥漫性大 B 细胞淋巴瘤化疗免疫治疗后无进展生存的早期和优越预测指标：一项多中心研究。
F-Fluorothymidine PET is an early and superior predictor of progression-free survival following chemoimmunotherapy of diffuse large B cell lymphoma: a multicenter study.
机构信息
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University Medical Center, Stanford, CA, USA.
Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
出版信息
Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2883-2893. doi: 10.1007/s00259-021-05353-9. Epub 2021 Apr 28.
PURPOSE
To determine whether interim 3'-deoxy-3'-[F]fluorothymidine (iFLT) PET/CT is a superior predictor of progression-free survival (PFS) compared with interim F-fluorodeoxyglucose (iFDG) PET/CT in patients with diffuse large B cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH).
METHODS
Ninety-two prospectively enrolled patients with DLBCL underwent both FLT-PET/CT and FDG-PET/CT 18-24 days after two cycles of R-CHOP/R-EPOCH. Deauville-criteria, PERCIST1.0, standardized uptake value (SUV), total lesion glycolysis (TLG), and metabolic tumor volume were used to interpret iFDG-PET/CT while dichotomous visual interpretation was used to interpret iFLT-PET/CT and the results were compared with the 3- and 5-year PFS.
RESULTS
iFLT-PET/CT was negative in 67 (73%) and positive in 25 (27%) patients. iFDG-PET/CT by Deauville criteria was negative (Deauville scores [DS] of 1-3) in 53 (58%) and positive (DS = 4-5) in 39 (42%) patients. Of the 67 iFLT-PET/CT-negative patients, 7 (10.4%) progressed at a median of 14.1 months whereas 14/25 (56.0%) iFLT-PET/CT-positive patients progressed at a median of 7.8 months (P < .0001). Of the 53 Deauville-negative patients, 9 (17.0%) progressed at a median of 14.1 months whereas 12/39 (30.8%) Deauville-positive patients progressed at a median of 5.6 months (P = .11). In multivariate analysis, including iFLT-PET/CT, PERCIST, interim TLG, and interim SUV, only iFLT-PET/CT was an independent predictor for 3- and 5-year PFS (P < .0001 and P = .001, respectively).
CONCLUSIONS
In patients with DLBCL given R-CHOP/R-EPOCH, iFLT-PET/CT is a superior independent predictor of outcome compared with iFDG-PET/CT.
目的
比较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）或利妥昔单抗联合依托泊苷、泼尼松、长春新碱、环磷酰胺和多柔比星（R-EPOCH）治疗弥漫性大 B 细胞淋巴瘤（DLBCL）患者，治疗后 18-24 天进行 3'-脱氧-3'-[F]氟胸苷（iFLT）PET/CT 与氟脱氧葡萄糖（iFDG）PET/CT 检查，哪种方法能够更好地预测无进展生存期（PFS）。
方法
92 例经前瞻性入组的 DLBCL 患者在接受 R-CHOP/R-EPOCH 治疗两个周期后，分别进行 FLT-PET/CT 和 FDG-PET/CT 检查。采用 Deauville 标准、PERCIST1.0、标准摄取值（SUV）、总病变糖酵解（TLG）和代谢肿瘤体积来解读 iFDG-PET/CT，而采用二项式视觉解读来解读 iFLT-PET/CT，并将结果与 3 年和 5 年的 PFS 进行比较。
结果
67 例患者的 iFLT-PET/CT 结果为阴性（73%），25 例患者的 iFLT-PET/CT 结果为阳性（27%）。根据 Deauville 标准，53 例患者的 iFDG-PET/CT 结果为阴性（Deauville 评分[DS]为 1-3），39 例患者的 iFDG-PET/CT 结果为阳性（DS=4-5）。在 67 例 iFLT-PET/CT 阴性患者中，有 7 例（10.4%）在中位时间 14.1 个月时进展，而 25 例 iFLT-PET/CT 阳性患者中有 14 例（56.0%）在中位时间 7.8 个月时进展（P<0.0001）。在 53 例 Deauville 阴性患者中，有 9 例（17.0%）在中位时间 14.1 个月时进展，而 39 例 Deauville 阳性患者中有 12 例（30.8%）在中位时间 5.6 个月时进展（P=0.11）。在包括 iFLT-PET/CT、PERCIST、中期 TLG 和中期 SUV 的多变量分析中，只有 iFLT-PET/CT 是 3 年和 5 年 PFS 的独立预测因素（P<0.0001 和 P=0.001）。
结论
在接受 R-CHOP/R-EPOCH 治疗的 DLBCL 患者中，与 iFDG-PET/CT 相比，iFLT-PET/CT 是更好的独立预后预测因子。
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