Faculty of Medicine, Department of Hematology, Medical School of Clinical Medicine, University of Debrecen, Debrecen, Hungary.
Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary.
PLoS One. 2022 Aug 4;17(8):e0272787. doi: 10.1371/journal.pone.0272787. eCollection 2022.
Follicular lymphoma (FL) is an indolent, yet heterogeneous, B-cell lymphoproliferative disorder. Although most FL patients respond well to treatment, few with specific traits have a poor prognosis; the latter are difficult to define.
We retrospectively analyzed data from 143 FL patients treated at the University of Debrecen since 2009 and investigated prognostic factors that may influence the survival of FL patients.
A maximum standardized uptake value (SUVmax) cut-off of 9.85 at the staging positron emission tomography/computed tomography (PET/CT) (p = 0.0001, hazard ratio [HR]: 0.2535, 95% confidence interval [CI]: 0.1118-0.4878) and a lymphocyte/monocyte (Ly/Mo) ratio of 3.41 (p = 0.0027, HR: 2.997, 95% CI: 1.463-6.142), drawn at diagnosis, significantly predicted FL patients' progression-free survival (PFS). A staging SUVmax >9.85 with Ly/Mo <3.41 could delineate a high-risk group of FL patients (p<0.0001, HR: 0.0957, 95% CI: 0.03416-0.2685). Similarly, a significant difference was shown with an SUVmax cut-off of 3.15 at the interim PET/CT (p<0.0001, HR: 0.1614, 95% CI: 0.06684-0.3897). A staging SUVmax >9.85 in conjunction with interim SUVmax >3.15 predicted poor prognosis (p<0.0001, HR: 0.1037, 95% CI: 0.03811-0.2824). The PFS difference was translated into overall survival (OS) advantage (p = 0.0506, HR: 0.1187, 95% CI: 0.01401-1.005).
Biological prognostic factors, such as the Ly/Mo ratio, may improve the prognostic assessment of staging PET/CT. The survival advantage observed in PFS is translated into OS when determined using a combination of staging and interim SUVmax. We recommend investigating additional biological prognostic factors while highlighting the role of PET/CT in FL.
滤泡性淋巴瘤（FL）是一种惰性但具有异质性的 B 细胞淋巴瘤。尽管大多数 FL 患者对治疗反应良好，但少数具有特定特征的患者预后较差；后者难以定义。
我们回顾性分析了自 2009 年以来在德布勒森大学治疗的 143 例 FL 患者的数据，并研究了可能影响 FL 患者生存的预后因素。
分期正电子发射断层扫描/计算机断层扫描（PET/CT）的最大标准化摄取值（SUVmax）截断值为 9.85（p=0.0001，风险比[HR]：0.2535，95%置信区间[CI]：0.1118-0.4878）和诊断时的淋巴细胞/单核细胞（Ly/Mo）比值为 3.41（p=0.0027，HR：2.997，95%CI：1.463-6.142），显著预测了 FL 患者的无进展生存期（PFS）。分期 SUVmax>9.85 伴 Ly/Mo<3.41 可描绘出 FL 患者的高危组（p<0.0001，HR：0.0957，95%CI：0.03416-0.2685）。同样，中期 PET/CT 的 SUVmax 截断值为 3.15 也显示出显著差异（p<0.0001，HR：0.1614，95%CI：0.06684-0.3897）。分期 SUVmax>9.85 结合中期 SUVmax>3.15 预测预后不良（p<0.0001，HR：0.1037，95%CI：0.03811-0.2824）。PFS 差异转化为 OS 优势（p=0.0506，HR：0.1187，95%CI：0.01401-1.005）。
生物学预后因素，如 Ly/Mo 比值，可能改善分期 PET/CT 的预后评估。当使用分期和中期 SUVmax 的组合时，在 PFS 中观察到的生存优势转化为 OS。我们建议在强调 PET/CT 在 FL 中的作用的同时，研究其他生物学预后因素。
