Lu Xia, Wei Ang, Wang Guanyun, Du Junye, Feng Lijuan, Ou Wenxin, Wang Tianyou, Wang Wei, Li Jixia, Zhang Mingyu, Zhang Rui, Yang Jigang
Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Quant Imaging Med Surg. 2023 Sep 1;13(9):5934-5944. doi: 10.21037/qims-23-290. Epub 2023 Aug 4.
Langerhans cell histiocytosis (LCH) is a rare myeloid precursor cell inflammatory neoplasia, which agonizes, maims, and even kills patients. Although clinical outcomes have steadily improved over the past decades, the progression/relapse rate of LCH remains high. The purpose of this study was to evaluate the prognostic value of the pre-treatment metabolism parameters of baseline F-fluorodeoxyglucose positron emission tomography/computed tomography (F‑FDG PET/CT) in children with LCH.
This cross-sectional study retrospectively and consecutively included 37 children (24 males and 13 females; median age, 5.1 years; range, 2.4-7.8 years) with pre-treatment F-FDG PET/CT from September 2020 to September 2022 in Nuclear Medicine Department, Beijing friendship hospital, Capital Medical University, Beijing, China. These patients were then all admitted to the hospital and diagnosed with LCH by biopsy, in Hematology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China. Five metabolism parameters of F-FDG PET/CT were analyzed, including maximum standardized uptake, tumor-to-normal liver standard uptake value ratio, tumor-to-normal bone marrow standard uptake value ratio, sum of metabolic tumor volume (sMTV), and sum of total lesion glycolysis (sTLG) of all lesions. Patients were followed up for at least 1 year or until disease progression/relapse. Univariate and multivariate analyses of progression-free survival was performed.
During follow-up, 11 (29.7%) patients had disease progression/relapse. Univariate analysis revealed that the risk organ involvement, the treatment response at the 5 or 11 week, pre-treatment sMTV, and sTLG were significantly associated with progression-free survival (P=0.024, 0.018, 0.006, 0.006, and 0.042, respectively). Multivariate COX analysis revealed that non-response at the 11 week, pre-treatment sMTV >32.55 g/cm, and sTLG >98.86 g (P=0.002, 0.020, 0.026, respectively) were risk factors for progression-free survival.
The baseline metabolism parameters of F-FDG PET/CT could be promising imaging biomarkers for predicting prognosis in children with LCH.
朗格汉斯细胞组织细胞增多症（LCH）是一种罕见的髓系前体细胞炎性肿瘤，会使患者痛苦、致残甚至死亡。尽管在过去几十年中临床结果稳步改善，但LCH的进展/复发率仍然很高。本研究的目的是评估基线氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）的治疗前代谢参数对LCH患儿的预后价值。
本横断面研究回顾性连续纳入了2020年9月至2022年9月在中国北京首都医科大学附属北京友谊医院核医学科进行治疗前F-FDG PET/CT检查的37例儿童（24例男性和13例女性；中位年龄5.1岁；范围2.4 - 7.8岁）。这些患者随后均入住中国北京首都医科大学附属北京儿童医院血液科，通过活检确诊为LCH。分析了F-FDG PET/CT的五个代谢参数，包括最大标准化摄取值、肿瘤与正常肝脏标准摄取值比值、肿瘤与正常骨髓标准摄取值比值、所有病灶的代谢肿瘤体积总和（sMTV）以及总病灶糖酵解总和（sTLG）。对患者进行至少1年的随访或直至疾病进展/复发。进行无进展生存期的单因素和多因素分析。
随访期间，11例（29.7%）患者出现疾病进展/复发。单因素分析显示，危险器官受累、第5或11周的治疗反应、治疗前sMTV和sTLG与无进展生存期显著相关（P分别为0.024、0.018、0.006、0.006和0.042）。多因素COX分析显示，第11周无反应、治疗前sMTV>32.55 g/cm和sTLG>98.86 g（P分别为0.002、0.020、0.026）是无进展生存期的危险因素。
F-FDG PET/CT的基线代谢参数可能是预测LCH患儿预后的有前景的影像学生物标志物。
