基线^(18)F-FDG PET/CT代谢参数在ENKTL中的预后价值  

The prognostic role of^(18)F-FDG PET/CT baseline metabolic parameters in extranodal natural killer/T-cell lymphoma

作　　者：孙寒 丁重阳[1] 丁威 巩环宇 周紫薇 唐立钧[1] SUN Han;DING Chongyang;DING Wei;GONG Huanyu;ZHOU Ziwei;TANG Lijun(Department of Nuclear Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院核医学科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2023年第2期249-256,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省医学重点人才基金(ZDRCB2016003)。

摘　　要：目的:探讨结外NK/T细胞淋巴瘤(extranodal natural killer/T-cell lymphoma,ENKTL)患者基线^(18)F-脱氧葡萄糖(^(18)Ffluorodeoxy glucose,^(18)F-FDG)正电子发射计算机断层显像(positron emission tomography/computed tomography,PET/CT)代谢参数的预后价值。方法:回顾性分析83例初诊ENKTL患者治疗前的临床及PET/CT资料。以最大标准摄取值(maximum standardized uptake value,SUVmax)的41%作为阈值,获得全身病灶的SUVmax、肿瘤代谢总体积(total metabolic tumor volume,TMTV)和糖酵解总量(totallesion glycolysis,TLG)。Kaplan-Meier曲线和Log-rank检验用于生存分析,多因素分析使用Cox比例风险回归。结果:中位随访21.6(8.9,38.3)个月,其中37(44.6%)例患者进展,32(38.6%)例死亡。受试者工作特征(receiver-operating characteristic,ROC)曲线获得SUVmax、TMTV、TLG预测预后的最佳临界值分别为16.7、64.9 cm^(3)和490.4。单因素分析显示高SUVmax、TMTV、TLG与较差的无进展生存(progression-free survival,PFS)率和总生存(overall survival,OS)率有关。多因素分析表明TMTV、TLG和NK细胞淋巴瘤预后指数(prognostic index of natural killer lymphoma,PINK)是影响PFS(HR 5.411,P=0.001;HR 7.905,P<0.001;HR 2.858,P=0.011)与OS(HR 6.137,P=0.002;HR 8.014,P<0.001;HR 2.666,P=0.023)的独立危险因素,治疗模式和β2-微球蛋白(β2-microglobulin,β2-MG)分别为PFS和OS的独立预后因素(HR 2.323,P=0.021;HR 2.627,P=0.021)。TMTV与PINK评分结合可以优化预后分层。结论:ENKTL患者基线高SUVmax、TMTV、TLG可以预测不良预后,TMTV、TLG和PINK评分为PFS和OS的独立预测因子。此外,TMTV和PINK联合可以更好地对患者进行风险分层。Objective:The aim of this study was to investigate the prognostic role of baseline metabolic parameters of^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)imaging in patients with extranodal natural killer/T-cell lymphoma(ENKTL).Methods:Eighty-three patients newly diagnosed with ENKTL who underwent pretreatment^(18)F-FDG PET/CT scans were enrolled in this study.The baseline maximum standardized uptake value(SUVmax),total metabolic tumor volume(TMTV),total lesion glycolysis(TLG),and clinical characteristics were collected for the retrospective analysis.TMTV was defined using the 41%SUVmax threshold.Kaplan-Meier curve(Log-rank test)was used for survival analysis.The statistically significant factors in the univariate analysis were incorporated into the Cox proportional hazards model for multivariate survival analysis.Results:Thirty-seven(44.6%)patients progressed and 32(38.6%)patients died within a median follow-up time of 21.6(8.9,38.3)months.The receiver operating curve(ROC)analysis indicated that the optimal cut-off values of SUVmax,TMTV and TLG were 16.7,64.9 cm^(3)and490.4,respectively.Patients with higher SUVmax,TMTV and TLG had worse prognosis.In multivariate analysis,TMTV,TLG and prognostic index of natural killer lymphoma(PINK)were independent prognostic factors of both PFS(HR 5.411,P=0.001;HR 7.905,P<0.001;HR 2.858,P=0.011)and OS(HR 6.137,P=0.002;HR 8.014,P<0.001;HR 2.666,P=0.023),treatment mode andβ2-microglobulin(β2-MG)were independent prognostic predictors of PFS and OS,respectively(HR 2.323,P=0.021;HR 2.627,P=0.021).TMTV,together with PINK,may have better risk stratification performance in ENKTL patients.Conclusions:Baseline high SUVmax,TMTV and TLG can predict a relatively poor prognosis in patients with ENKTL,TMTV,TLG and PINK are independent predictors for survival outcomes.Moreover,the combination of TMTV and PINK may provide better risk substratification in PFS and OS.

关 键 词：ENKTL 预后 PET/CT ^(18)F-FDG 

分 类 号：R814.42[医药卫生—影像医学与核医学]