Oh Minyoung, Cho Hyungwoo, Park Ji Eun, Kim Ho Sung, Go Heounjeong, Park Chan-Sik, Lee Sang-Wook, Song Sang Woo, Kim Young-Hoon, Cho Young Hyun, Hong Seok Ho, Kim Jeong Hoon, Lee Dong Yun, Ryu Jin-Sook, Yoon Dok Hyun, Kim Jae Seung
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Neuro Oncol. 2024 Dec 5;26(12):2377-2387. doi: 10.1093/neuonc/noae146.
The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in the prognostication and response evaluation of primary central nervous system lymphoma (PCNSL) remains inadequately defined.
We conducted a retrospective analysis of 268 consecutive newly diagnosed patients with PCNSL between 2006 and 2020. Of these patients, 105 and 110 patients were included to evaluate the prognostic value of baseline and post-treatment 18F-FDG-PET/CT scans, respectively. Tumor uptake was considered positive when it exceeded that of the contralateral brain upon visual assessment. Quantitative analysis of baseline 18F-FDG-PET/CT included measurement of the maximal standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), and total lesion glycolysis (TLG).
The median age of the 268 patients was 62 years (range: 17-85), with 55% being male. The median progression-free survival (PFS) was 24.5 months (95% CI: 19.9-29.1), and the median overall survival (OS) was 34.5 months (95% CI: 22.9-46.1). The average SUVmax was 15.3 ± 5.7 and the mean TMTV and TLG were 12.6 ± 13.9 cm3 and 135.0 ± 152.7 g, respectively. Patients with a baseline TMTV ≥ 17.0 cm3 had significantly shorter OS (12.5 vs 74.0 months, P = .011). Post-treatment metabolic response by 18F-FDG-PET/CT significantly predicted PFS (median: 10.5 vs 46.0 months, P = .001) and OS (median: 21.0 vs 62.0 months, P = .002), whereas anatomic response by contrast-enhanced MRI showed no statistically significant differences in PFS (P = .130) or OS (P = .540).
Baseline TMTV and post-treatment metabolic response, as assessed by 18F-FDG-PET/CT, are significant prognostic factors in patients with PCNSL.
18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG-PET/CT）在原发性中枢神经系统淋巴瘤（PCNSL）的预后评估和疗效评价中的作用仍未得到充分明确。
我们对2006年至2020年间连续确诊的268例PCNSL新发病例进行了回顾性分析。其中，分别纳入105例和110例患者以评估基线和治疗后18F-FDG-PET/CT扫描的预后价值。视觉评估时，当肿瘤摄取超过对侧脑时，认为肿瘤摄取为阳性。基线18F-FDG-PET/CT的定量分析包括测量最大标准化摄取值（SUVmax）、总代谢肿瘤体积（TMTV）和总病变糖酵解（TLG）。
268例患者的中位年龄为62岁（范围：17 - 85岁），男性占55%。中位无进展生存期（PFS）为24.5个月（95%CI：19.9 - 29.1），中位总生存期（OS）为34.5个月（95%CI：22.9 - 46.1）。平均SUVmax为15.3±5.7，平均TMTV和TLG分别为12.6±13.9 cm³和135.0±152.7 g。基线TMTV≥17.0 cm³的患者OS显著缩短（12.5个月对74.0个月，P = 0.011）。18F-FDG-PET/CT评估的治疗后代谢反应显著预测了PFS（中位值：10.5个月对46.0个月，P = 0.001）和OS（中位值：21.0个月对62.0个月，P = 0.002），而对比增强MRI评估的解剖学反应在PFS（P = 0.130）或OS（P = 0.540）方面无统计学显著差异。
18F-FDG-PET/CT评估的基线TMTV和治疗后代谢反应是PCNSL患者的重要预后因素。
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