Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China.
Eur Radiol. 2022 Aug;32(8):5568-5576. doi: 10.1007/s00330-022-08624-7. Epub 2022 Mar 22.
To investigate if baseline [F]FDG PET/CT can predict the outcome of follicular lymphoma (FL) in patients managed with an initial "watch-and-wait" approach.
Thirty-eight newly diagnosed FL patients who were managed with an initial "watch-and-wait" approach and undergone baseline [F]FDG PET/CT were retrospectively enrolled. The standard uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of FL lesions were measured on PET/CT. Patients were followed up for at least 24 months or until initiation of FL therapy. The endpoint was the time to initiation of lymphoma treatment (TLT).
After a median follow-up of 28 months (range 3-94 months), lymphoma treatment was initiated in 21/38 (55.3%) patients (median 15 months, range 3-51 months). Patients with TLT < 24 months showed SUVmax and TLG values significantly higher than those with TLT ≥ 24 months (p < 0.05). Receiver operating characteristic analysis demonstrated cutoff values of SUVmax > 9.5, MTV > 90.62 ml, and TLG > 144.96 SUVbwml were optimal for predicting TLT < 24 months. Kaplan-Meier analysis showed SUVmax > 9.5, MTV > 90.62 ml, and TLG > 144.96 SUVbwml had statistically significant correlations with shorter TLT (p < 0.01). Lymph node regions ≥ 3 and lymph nodes > 3 cm had almost significance (p < 0.1). In multivariate analysis, SUVmax > 9.5 (HR 3.2 [95% CI 1.1-9.2], p = 0.033) and TLG > 144.96 SUVbw*ml (HR 9.3 [95% CI 1.8-47.7], p = 0.008) were demonstrated to be independent predictive factors for shorter TLT.
Metabolic indices (SUVmax and TLG) of baseline [F]FDG PET/CT could predict the outcome independently in FL patients under an initial "watch-and-wait" approach.
• "Watch-and-wait" approach is part of the overall treatment plan in asymptomatic patients with low tumor burden FL. However, the time to initiation of active treatment varies from months to years. • In our retrospective study of 38 patients with FL managed with an initial "watch-and-wait" approach, the SUVmax and TLG were demonstrated to be independent predictive factors for time to initiation of FL treatment. • Baseline [F]FDG PET/CT may help to better select patients with FL who are most likely to benefit from "watch-and-wait" management.
探讨基线 [F]FDG PET/CT 是否可以预测初始“观察等待”方法治疗滤泡性淋巴瘤 (FL) 患者的结局。
回顾性纳入 38 例新诊断为 FL 且接受初始“观察等待”方法治疗的患者，所有患者均进行基线 [F]FDG PET/CT 检查。在 PET/CT 上测量 FL 病变的标准摄取值 (SUV)、代谢肿瘤体积 (MTV) 和总病变糖酵解 (TLG)。对患者进行至少 24 个月的随访，或直至开始 FL 治疗。终点为开始淋巴瘤治疗的时间 (TLT)。
中位随访 28 个月（范围 3-94 个月）后，21/38 (55.3%) 例患者（中位时间 15 个月，范围 3-51 个月）开始淋巴瘤治疗。TLT<24 个月的患者 SUVmax 和 TLG 值明显高于 TLT≥24 个月的患者（p<0.05）。受试者工作特征分析显示 SUVmax>9.5、MTV>90.62ml 和 TLG>144.96SUVbwml 是预测 TLT<24 个月的最佳截断值。Kaplan-Meier 分析显示 SUVmax>9.5、MTV>90.62ml 和 TLG>144.96SUVbwml 与 TLT 缩短有统计学显著相关性（p<0.01）。淋巴结区域≥3 和淋巴结>3cm 具有几乎显著的相关性（p<0.1）。多变量分析显示，SUVmax>9.5（HR 3.2[95%CI 1.1-9.2]，p=0.033）和 TLG>144.96SUVbw*ml（HR 9.3[95%CI 1.8-47.7]，p=0.008）是 TLT 缩短的独立预测因素。
初始“观察等待”方法治疗的 FL 患者基线 [F]FDG PET/CT 的代谢指标（SUVmax 和 TLG）可独立预测结局。
“观察等待”方法是低肿瘤负荷 FL 无症状患者整体治疗计划的一部分。然而，开始积极治疗的时间从数月到数年不等。
在我们对 38 例接受初始“观察等待”方法治疗的 FL 患者的回顾性研究中，SUVmax 和 TLG 被证明是 FL 治疗开始时间的独立预测因素。
基线 [F]FDG PET/CT 可能有助于更好地选择最有可能从“观察等待”管理中受益的 FL 患者。
