^(18)F-FDG PET/CT联合临床分期/评分系统对鼻型结外自然杀伤/T细胞淋巴瘤的预后价值  

Prognostic value of ^(18)F-FDG PET/CT combined with clinical staging/scoring system in nasal extranodal natural killer/T-cell lymphoma

作　　者：吕玉虎 尹梁澜 夏晓天[1] 张永学[1] 兰晓莉[1] 覃春霞[1] Lyu Yuhu;Yin Lianglan;Xia Xiaotian;Zhang Yongxue;Lan Xiaoli;Qin Chunxia(Department of Nuclear Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院核医学科、分子影像湖北省重点实验室,武汉430022

出　　处：《中华核医学与分子影像杂志》2024年第3期134-140,共7页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的比较并筛选测量鼻型结外自然杀伤/T细胞淋巴瘤(ENKTL)肿瘤代谢体积(MTV)的最佳方法,评价^(18)F-FDG PET/CT代谢参数及临床分期/评分系统对鼻型ENKTL患者的预后价值,并探讨二者联合对预后预测的增益价值。方法回顾性收集2016年1月至2022年9月于华中科技大学同济医学院附属协和医院经病理确诊为鼻型ENKTL并于治疗前行^(18)F-FDG PET/CT显像的患者44例[男26例、女18例,年龄(47.5±13.6)岁],采用SUV 2.5、SUV 4.0及41%SUVmax分别作为阈值测量MTV及病灶糖酵解总量(TLG),采用Bland-Altman检验分析不同方法测量结果的一致性,并利用ROC曲线比较不同方法的预后预测效能;采用校正χ^(2)检验分析不同临床因素及临床分期/评分系统组间死亡率的差异。采用Cox比例风险模型进行多因素分析,并采用logistic回归方法构建联合诊断模型。结果 44例患者中,6例(13.6%)死亡,总生存(OS)为32.05(11.77,64.43)个月,2年、5年OS率分别为86.6%、82.5%。年龄(≥60和<60岁)、自然杀伤细胞淋巴瘤预后指数(PINK)评分、国际预后指数(IPI)评分低危和高危组间死亡率差异有统计学意义(χ^(2)值:5.02、4.12、3.88,均P<0.05)。不同阈值法测量的MTV之间一致性良好,以SUV 2.5作为阈值测量的MTV具有较高的预后预测效能(AUC=0.737)。多因素Cox回归分析示MTV[风险比(HR)=10.488,95%CI:1.864~59.026,P=0.008]是OS的独立影响因素。通过去除其他因素得到最小化模型,其中包括MTV和PINK评分(P值:0.006、0.048),MTV、PINK评分及两者联合诊断预测模型的AUC分别为0.781、0.741及0.912,联合诊断预测模型可提高预后预测效能。结论 SUV 2.5作为阈值测量MTV具有较好的预后预测效能;MTV为影响鼻型ENKTL患者OS的独立因素,MTV联合PINK评分具有更好的预后预测效能。Objective To compare and choose the best method for measuring metabolic tumor volume(MTV)of nasal extranodal natural killer/T-cell lymphoma(ENKTL),evaluate the prognostic value of ^(18)F-FDG PET/CT metabolic parameters and clinical staging/scoring systems for patients with nasal ENKTL,and explore the added value of the two combinations for prognostic prediction.Methods From January 2016 to September 2022,44 patients(26 males,18 females;age(47.5±13.6)years)pathologically diagnosed with nasal ENKTL who underwent ^(18)F-FDG PET/CT imaging before treatment in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively collected.SUV 2.5,SUV 4.0 and 41%SUVmax were used as thresholds to measure MTV and total lesion glycolysis(TLG),and the consistency was analyzed by Bland-Altman analysis.The ROC curve analysis was used to compare the prognostic efficiency of different methods and determine the best method.The prognostic values of different clinical factors and clinical staging/scoring systems between groups were evaluated by correctedχ^(2) test.The independent factors were screened by Cox-regression model,and the combined diagnosis model was constructed by logistic regression.Results Of 44 patients,6(13.6%)were dead,with the overall survival(OS)of 32.05(11.77,64.43)months,and the 2-year and 5-year OS rates of 86.6%and 82.5%,respectively.The mortality of different groups in age(≥60 and<60 years),prognostic index of natural killer cell lymphoma(PINK)score(low-and high-risk),and international prognostic index(IPI)score(low-and high-risk)were significantly different(χ^(2) values:5.02,4.12,3.88,all P<0.05).The consistency of MTV measured by different thresholds was good.Among them,the MTV measured by threshold of SUV 2.5 had the highest predictive efficiency with the AUC of 0.737.Multivariate analysis showed that MTV(hazard ratio(HR)=10.488,95%CI:1.864-59.026,P=0.008)was the independent influencing factor of OS.By removing other factors,minimization model was obtained,includi

关 键 词：淋巴瘤 结外NK-T细胞 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 预后 

分 类 号：R733.1[医药卫生—肿瘤] R730.44[医药卫生—临床医学]