Department of Radiation Oncology, University of Colorado, Aurora, Colorado, USA.
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Pediatr Blood Cancer. 2021 Sep;68(9):e29212. doi: 10.1002/pbc.29212. Epub 2021 Jul 10.
Positron emission tomography (PET)-based measures of baseline total-body tumor burden may improve risk stratification in intermediate-risk Hodgkin lymphoma (HL).
Evaluable patients were identified from a cohort treated homogeneously with the same combined modality regimen on the Children's Oncology Group AHOD0031 study. Eligible patients had high-quality baseline PET scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were each measured based on 15 thresholds for every patient. Univariate and multivariable Cox regression and Kaplan-Meier survival analyses assessed for an association of MTV and TLG with event-free survival (EFS).
From the AHOD0031 cohort (n = 1712), 86 patients were identified who (i) were treated with four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy followed by involved field radiotherapy, and (ii) had a baseline PET scan that was amenable to quantitative analysis. Based on univariate Cox regression analysis, six PET-derived parameters were significantly associated with EFS. For each of these, Kaplan-Meier analyses and the log-rank test were used to compare patients with highest tumor burden (i.e., highest 15%) to the remainder of the cohort. EFS was significantly associated with all six PET parameters (all p < .029). In a multivariable model controlling for important covariates including disease bulk and response to chemotherapy, MTV was significantly associated with EFS (p = .012).
Multiple baseline PET-derived volumetric parameters were associated with EFS. MTV was highly associated with EFS when controlling for disease bulk and response to chemotherapy. Incorporation of baseline MTV into risk-based treatment algorithms may improve outcomes in intermediate-risk HL.
正电子发射断层扫描（PET）测量的基线全身肿瘤负荷可能改善中危霍奇金淋巴瘤（HL）的风险分层。
从接受儿童肿瘤学组 AHOD0031 研究中相同联合治疗方案同质治疗的队列中确定可评估的患者。合格的患者具有高质量的基线 PET 扫描。为每位患者测量代谢肿瘤体积（MTV）和总病变糖酵解（TLG），每个测量都基于 15 个阈值。单变量和多变量 Cox 回归以及 Kaplan-Meier 生存分析评估了 MTV 和 TLG 与无事件生存（EFS）的相关性。
从 AHOD0031 队列（n=1712）中，确定了 86 名患者（i）接受了四个周期的多柔比星、博来霉素、长春新碱、依托泊苷、泼尼松、环磷酰胺（ABVE-PC）化疗，然后接受了受累野放疗，（ii）基线 PET 扫描可进行定量分析。基于单变量 Cox 回归分析，有 6 个 PET 衍生参数与 EFS 显著相关。对于每个参数，Kaplan-Meier 分析和对数秩检验用于比较肿瘤负担最高（即最高 15%）的患者与队列的其余部分。EFS 与所有 6 个 PET 参数均显著相关（均 p<0.029）。在多变量模型中，控制了疾病肿块和化疗反应等重要协变量后，MTV 与 EFS 显著相关（p=0.012）。
多个基线 PET 衍生的容积参数与 EFS 相关。在控制疾病肿块和化疗反应后，MTV 与 EFS 高度相关。将基线 MTV 纳入基于风险的治疗算法可能会改善中危 HL 的预后。
