Zhou Ziwei, Guo Zhe, Hu Qingqiao, Ding Wei, Ding Chongyang, Tang Lijun
Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China.
Onco Targets Ther. 2021 May 14;14:3179-3191. doi: 10.2147/OTT.S308872. eCollection 2021.
To explore regional brain glucose metabolic abnormalities of pretreatment stage I/II extranodal natural killer/T-cell lymphoma (ENKTL) patients using positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (F-FDG PET/CT) and assess its prognostic value.
Sixty pretreatment stage I/II ENKTL patients were enrolled in this retrospective study and divided into survival (n = 45) and death (n = 15) groups according to their status at the end of follow-up. A control group consisted of 60 healthy subjects. Regional cerebral glucose metabolism was evaluated on a voxel-by-voxel basis using statistical parametric mapping (SPM8) under a certain significance level (P < 0. 001) and voxel threshold (K = 100 voxels).
Decreased metabolism was noted in patients, involving the bilateral prefrontal and orbitofrontal cortex, partial parietal and occipital cortex, cingulate gyrus and cerebellum; the sensorimotor cortex was largely spared. Increased metabolism was observed in the bilateral putamen, amygdala, and parahippocampal gyrus. Compared with the survival group, the death group had higher metabolism in the bilateral amygdala, putamen, left thalamus, uncus, and parahippocampal gyrus. Only B symptoms were associated with the increased metabolism of basal ganglia and thalamus (BGT). Patients with high metabolic tumor volume, total lesion glycolysis (TLG) and BGT metabolism had a poor prognosis. TLG and maximum standardized uptake value (SUVmax) LBGT/SUVmaxRight cerebellum were associated with Eastern Cooperative Oncology Group (ECOG) and prognostic index of natural killer lymphoma and Epstein-Barr virus-DNA (PINKE) scores. In multivariate analysis, only ECOG was an independent prognostic factor of both progression-free survival (PFS) and overall survival (OS). PINKE was an independent prognostic factor of OS.
Pretreatment stage I/II ENKTL patients exhibited abnormal regional cerebral glucose metabolism. Higher pretreatment glucose metabolism in BGT could predict a relatively poor prognosis but did not surpass the predictive values of ECOG and PINKE in stage I/II ENKTL patients.
采用2-脱氧-2-[氟-18]氟-D-葡萄糖正电子发射断层显像联合计算机断层扫描（F-FDG PET/CT）探讨初治Ⅰ/Ⅱ期结外自然杀伤/T细胞淋巴瘤（ENKTL）患者的脑区葡萄糖代谢异常情况，并评估其预后价值。
本回顾性研究纳入60例初治Ⅰ/Ⅱ期ENKTL患者，根据随访结束时的状态分为生存组（n = 45）和死亡组（n = 15）。对照组由60名健康受试者组成。在一定显著性水平（P < 0. 001）和体素阈值（K = 100体素）下，使用统计参数映射（SPM8）逐体素评估脑区葡萄糖代谢。
患者出现代谢降低，累及双侧前额叶和眶额叶皮质、部分顶叶和枕叶皮质、扣带回和小脑；感觉运动皮质大多未受影响。双侧壳核、杏仁核和海马旁回代谢增加。与生存组相比，死亡组双侧杏仁核、壳核、左侧丘脑、钩回和海马旁回代谢更高。仅B症状与基底节和丘脑（BGT）代谢增加相关。高代谢肿瘤体积、总病变糖酵解（TLG）和BGT代谢的患者预后较差。TLG和最大标准化摄取值（SUVmax）LBGT/SUVmax右小脑与东部肿瘤协作组（ECOG）以及自然杀伤淋巴瘤和爱泼斯坦-巴尔病毒DNA预后指数（PINKE）评分相关。多因素分析中，仅ECOG是无进展生存期（PFS）和总生存期（OS）的独立预后因素。PINKE是OS的独立预后因素。
初治Ⅰ/Ⅱ期ENKTL患者存在脑区葡萄糖代谢异常。BGT较高的治疗前葡萄糖代谢可预测预后相对较差，但在Ⅰ/Ⅱ期ENKTL患者中未超过ECOG和PINKE的预测价值。
