代谢肿瘤体积可预测 RELEVANCE 试验中晚期滤泡淋巴瘤患者的结局。
Metabolic tumor volume predicts outcome in patients with advanced stage follicular lymphoma from the RELEVANCE trial.
机构信息
Department of Nuclear Medicine, Cochin Hospital, AP-HP, Université Paris Cité, Paris.
LITO Laboratory, UMR 1288 Inserm, Institut Curie, Université Paris-Saclay, Orsay; Siemens Healthcare SAS, Saint Denis, France.
出版信息
Ann Oncol. 2024 Jan;35(1):130-137. doi: 10.1016/j.annonc.2023.10.121. Epub 2023 Oct 28.
BACKGROUND
We investigated the prognostic value of baseline positron emission tomography (PET) parameters for patients with treatment-naïve follicular lymphoma (FL) in the phase III RELEVANCE trial, comparing the immunomodulatory combination of lenalidomide and rituximab (R) versus R-chemotherapy (R-chemo), with both regimens followed by R maintenance therapy.
PATIENTS AND METHODS
Baseline characteristics of the entire PET-evaluable population (n = 406/1032) were well balanced between treatment arms. The maximal standard uptake value (SUV) and the standardized maximal distance between tow lesions (SD) were extracted, the standardized distance between two lesions the furthest apart, were extracted. The total metabolic tumor volume (TMTV) was computed using the 41% SUV method.
RESULTS
With a median follow-up of 6.5 years, the 6-year progression-free survival (PFS) was 57.8%, the median TMTV was 284 cm, SUV was 11.3 and SD was 0.32 m, with no significant difference between arms. High TMTV (>510 cm) and FLIPI were associated with an inferior PFS (P = 0.013 and P = 0.006, respectively), whereas SUV and SD were not (P = 0.08 and P = 0.12, respectively). In multivariable analysis, follicular lymphoma international prognostic index (FLIPI) and TMTV remained significantly associated with PFS (P = 0.0119 and P = 0.0379, respectively). These two adverse factors combined stratified the overall population into three risk groups: patients with no risk factors (40%), with one factor (44%), or with both (16%), with a 6-year PFS of 67.7%, 54.5%, and 41.0%, respectively. No significant interaction between treatment arms and TMTV or FLIPI (P = 0.31 or P = 0.59, respectively) was observed. The high-risk group (high TMTV and FLIPI 3-5) had a similar PFS in both arms (P = 0.45) with a median PFS of 68.4% in the R-chemo arm versus 71.4% in the R arm.
CONCLUSIONS
Baseline TMTV is predictive of PFS, independently of FLIPI, in patients with advanced FL even in the context of antibody maintenance.
背景
我们研究了未经治疗的滤泡性淋巴瘤（FL）患者在 III 期 RELAVANCE 试验中基线正电子发射断层扫描（PET）参数的预后价值，比较了来那度胺和利妥昔单抗（R）的免疫调节联合治疗与 R-化疗（R-chemo），两种方案均随后进行 R 维持治疗。
方法
整个 PET 可评估人群（n=406/1032）的基线特征在治疗臂之间平衡良好。提取最大标准摄取值（SUV）和最大病变间标准化距离（SD），提取最远病变间的标准化距离。使用 41% SUV 法计算总代谢肿瘤体积（TMTV）。
结果
中位随访 6.5 年后，6 年无进展生存率（PFS）为 57.8%，中位 TMTV 为 284cm，SUV 为 11.3，SD 为 0.32m，两臂之间无显著差异。高 TMTV（>510cm）和 FLIPI 与较差的 PFS 相关（P=0.013 和 P=0.006），而 SUV 和 SD 则没有（P=0.08 和 P=0.12）。多变量分析显示，滤泡性淋巴瘤国际预后指数（FLIPI）和 TMTV 与 PFS 显著相关（P=0.0119 和 P=0.0379）。这两个不良因素结合将总体人群分为三个风险组：无危险因素（40%）、有一个因素（44%）或有两个因素（16%），6 年 PFS 分别为 67.7%、54.5%和 41.0%。未观察到治疗臂与 TMTV 或 FLIPI 之间存在显著的交互作用（P=0.31 或 P=0.59）。高危组（高 TMTV 和 FLIPI 3-5）在两个臂中的 PFS 相似（P=0.45），R-chemo 臂的中位 PFS 为 68.4%，R 臂为 71.4%。
结论
即使在抗体维持的情况下，基线 TMTV 是预测晚期 FL 患者 PFS 的一个独立因素，优于 FLIPI。
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