Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center, P.O. Box 1269, Al- Jubeiha, Amman, 11941, Jordan.
School of Medicine, the University of Jordan, Amman, Jordan.
Sci Rep. 2022 Oct 21;12(1):17702. doi: 10.1038/s41598-022-22032-3.
The aim of the study was to assess the predictive value of interim FDG-PET/CT (iPET) in patients with Hodgkin's lymphoma (HL) treated with Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy. A total of 245 consecutive patients with de novo HL between 12/2013 and 12/2017 were evaluated retrospectively. All patients were treated with upfront ABVD, performed PET/CT scans at baseline, after 2 cycles (interim PET, iPET2) or 4 cycles (iPET4) and at the end of therapy, and followed up for at least 6 months after therapy. The response status on iPET was defined according to the standard five-point Deauville scores (DS) as follows: complete metabolic response (CMR, DS 1-3) and non-complete metabolic response (nCMR) (DS 4 and 5). End-of-treatment (EoT) response was assessed by FDG-PET/CT and if needed biopsy confirmation of PET-positive findings. The association between iPET and EoT response was investigated using logistic regression analysis. Survival analysis was performed using the Cox regression hazard model and Kaplan-Meier methods. Sixty-nine patients underwent iPET-2 and 176 iPET-4. No association was found between the timing of iPET and iPET response status (P-value = 0.71). Two hundred and one patients (82%) had iPET-CMR and 44 (18%) iPET -nCMR. iPET was strongly associated with EoT response status: 194/201 (96 .5%) of iPET-CMR had a complete response at the EoT while only 21/44 (47.7%) of patients with iPET-nCMR presented a complete response at EoT (P-value < 0.0001). The median follow-up was 32 months (range 6-81). Patients with iPET-CMR presented a better outcome with 91% 3 y event-free-survival (EFS) and 95% 3 y overall survival (OS) than those with iPET-nCMR (41 and 86%, respectively, P-value < 0.0001). In multivariable analyses, iPET retained an independent prognostic factor of EFS and OS (P-value < 0.0001 and P-value = 0.002, respectively). iPET is highly predictive of outcome of HL patients treated with ABVD and allows to tailor therapy to the individual patient.
本研究旨在评估氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在接受阿霉素、博来霉素、长春碱和达卡巴嗪（ABVD）化疗的霍奇金淋巴瘤（HL）患者中的预测价值。回顾性评估了 2013 年 12 月至 2017 年 12 月期间 245 例初治 HL 连续患者。所有患者均接受 ABVD 一线治疗，在基线、第 2 周期（中期 PET，iPET2）或第 4 周期（iPET4）时进行 PET/CT 扫描，并在治疗结束时进行扫描，且在治疗结束后至少进行 6 个月的随访。根据标准的五分制 Deauville 评分（DS）定义 iPET 时的反应状态：完全代谢反应（CMR，DS 1-3）和非完全代谢反应（nCMR）（DS 4 和 5）。治疗结束（EoT）反应通过 FDG-PET/CT 评估，如果需要对 PET 阳性发现进行活检确认。使用逻辑回归分析研究 iPET 与 EoT 反应之间的关系。使用 Cox 回归风险模型和 Kaplan-Meier 方法进行生存分析。69 例患者接受了 iPET-2，176 例患者接受了 iPET-4。iPET 的时间与 iPET 反应状态之间没有关联（P 值=0.71）。201 例（82%）患者 iPET-CMR，44 例（18%）患者 iPET-nCMR。iPET 与 EoT 反应状态密切相关：201 例 iPET-CMR 中，194 例（96.5%）在 EoT 时完全缓解，而 44 例 iPET-nCMR 中仅 21 例（47.7%）在 EoT 时完全缓解（P 值<0.0001）。中位随访时间为 32 个月（范围 6-81）。与 iPET-nCMR 相比，iPET-CMR 的患者具有更好的预后，3 年无事件生存率（EFS）为 91%，3 年总生存率（OS）为 95%（分别为 P 值<0.0001 和 P 值=0.002）。多变量分析显示，iPET 是 EFS 和 OS 的独立预后因素（P 值<0.0001 和 P 值=0.002）。iPET 对接受 ABVD 治疗的 HL 患者的预后具有高度预测性，并可根据个体患者的情况调整治疗方案。
