弥漫大B细胞淋巴瘤化疗中后期用~(18)F-FDGPET/CT显像预测预后是否优于化疗中期?
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摘要
目的探讨弥漫大B细胞淋巴瘤(DLBCL)患者在化疗中期和中后期进行18F-FDG PET/CT显像判断预后的价值差异。方法DLBCL初诊患者142例,于标准化疗第3~4个疗程结束进行首次18F-FDG PET/CT评价为化疗中期组,于标准化疗5~8个疗程结束进行首次PET/CT评价者为化疗中后期组,两组各有71例,首次PET/CT显像结果记录为阴性和阳性。所有患者随访18~114个月(平均28.73个月),根据随访结果计算无进展生存时间(PFS)和无进展生存率(PFS%),比较化疗中期组与中后期组患者首次18F-FDG PET/CT显像结果与预后的关系。结果化疗中期组18F-FDG PET/CT显像阴性和阳性率分别为63.4%、36.6%,化疗中后期组PET/CT显像阴性和阳性率分别为66.2%、33.8%,两组PET/CT显像阴性率及阳性率无明显差异(χ2=12.423,P>0.05)。PFS比较,化疗中期组首次18F-FDG PET/CT显像阴性和阳性者PFS分别为63.56和19.23个月(P=0.000),化疗中后期组首次PET/CT显像阴性和阳性者的PFS分别为65.78和24.32个月(P=0.000)。化疗中期组和中后期组首次PET/CT显像阴性者PFS时间无显著性差异(63.56 vs 65.78个月,P=0.613);化疗中期组和中后期组首次PET/CT显像阳性者PFS时间也无显著性差异(19.23 vs 24.32个月,P=0.274)。PFS率比较,化疗中期组首次PET/CT显像阴性和阳性者PFS率分别为73.3%、15.4%(χ2=12.423,P=0.000);化疗中后期组首次PET/CT显像阴性和阳性者PFS率分别为74.5%、16.7%(χ2=12.423,P=0.000)。化疗中期组和中后期组首次PET/CT显像阴性者的PFS率无明显统计学差异(73.3%vs74.5%,P=0.613);化疗中期和中后期组首次PET/CT显像阳性者的PFS率也无显著统计学差异(15.4%vs 16.7%,P=0.274)。结论 DLBCL在化疗中期和化疗中后期进行18F-FDG PET/CT显像均可较好地判断预后,在化疗中后期行PET/CT显像判断预后并不优于化疗中期,因此在化疗中期行18F-FDG PET/CT进行预测预后是合适的,不必延后到化疗中后期。
Objective To compare the value of18F- FDG PET/CT performed in the interim and later phase of chemotherapy in predicting the prognosis of diffuse large B- cell lymphoma(DLBCL). Methods18F- FDG PET/CT was performed in 71 patients with DLBCL in the interim phase of chemotherapy(3-4 cycles) and in another 71 patients in the later phase of chemotherapy(5-8 cycles). The patients were followed up for an average of 28.73 months(18- 114 months) to compare the progression- free survival(PFS) and the PFS rate. Results The positive finding rate was similar between18F- FDG PET/CT performed in the interim and the later phase(36.6% vs 33.8%, χ2 =12.423, P>0.05). The PFS was much longer in patients with negative findings than in those with positive findings in both the interim(63.56 vs 19.23 months, P=0.000) and later phase groups(65.78 vs 24.32 months, P=0.000), but showed no significant difference between the negative patients(P>0.05) or between the positive patients(P>0.05) in the two groups. The PFS rate was significantly greater in patients with negative than those with positive findings in the interim group(73.3% vs 15.4%, P=0.000) and in the later phase group(74.5% vs 16.7%, P=0.000), but comparable between the negative(P>0.05) and between the positive patients(P>0.05) in the two groups. Conclusions18F-FDG PET/CT in the interim and later phase of chemotherapy has similar value for predicting the prognosis of DLBCL, and we therefore recommend that18F-FDG PET/CT be performed in the interim but not in the later phase.
Objective To compare the value of18F- FDG PET/CT performed in the interim and later phase of chemotherapy in predicting the prognosis of diffuse large B- cell lymphoma(DLBCL). Methods18F- FDG PET/CT was performed in 71 patients with DLBCL in the interim phase of chemotherapy(3-4 cycles) and in another 71 patients in the later phase of chemotherapy(5-8 cycles). The patients were followed up for an average of 28.73 months(18- 114 months) to compare the progression- free survival(PFS) and the PFS rate. Results The positive finding rate was similar between18F- FDG PET/CT performed in the interim and the later phase(36.6% vs 33.8%, χ2 =12.423, P>0.05). The PFS was much longer in patients with negative findings than in those with positive findings in both the interim(63.56 vs 19.23 months, P=0.000) and later phase groups(65.78 vs 24.32 months, P=0.000), but showed no significant difference between the negative patients(P>0.05) or between the positive patients(P>0.05) in the two groups. The PFS rate was significantly greater in patients with negative than those with positive findings in the interim group(73.3% vs 15.4%, P=0.000) and in the later phase group(74.5% vs 16.7%, P=0.000), but comparable between the negative(P>0.05) and between the positive patients(P>0.05) in the two groups. Conclusions18F-FDG PET/CT in the interim and later phase of chemotherapy has similar value for predicting the prognosis of DLBCL, and we therefore recommend that18F-FDG PET/CT be performed in the interim but not in the later phase.
引文
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[13]王全师,吴湖炳,王明芳,等.18F-FDG显像对淋巴瘤分期及疗效评价的价值[J].中华核医学杂志,2004,24(1):8-10.
[14]Spaepen K,Stroobants S,Dupont P,et al.Early restaging positron emission tomography with(18)F-fluorodeoxyglucose predicts outcome in patients with aggressive non-Hodgkin's lymphoma[J].Ann Oncol,2002,13(9):1356-63.
[15]Cheson BD,Pfistner B,Juweid ME,et al.Revised response criteria for malignant lymphoma[J].J Clin Oncol,2007,25(5):579-86.
[16]Moskowitz CH,Schoeder H,Teruya-Feldstein JA,et al.Riskadapted dose-dense immunochemotherapy determined by interim FDG-PET in advanced-stage diffuse large B-cell lymphoma[J].J Clin Oncol,2010,28(11):1896-903.
[17]Horning SJ,Juweid ME,Schder H,et al.Interim positron emission tomography scans in diffuse large B-cell lymphoma:an Independent expert nuclear medicine evaluation of the Eastern Cooperative Oncology Group E3404 study[J].Blood,2010,115(4):775-7;quiz 918.
[18]Itti E,Juweid ME,Haioun C,et al.Improvement of early18F-FDG PET interpretation in diffuse large B-cell lymphoma:importance of the reference background[J].J Nucl Med,2010,51(12):1857-62.
[2]中华医学会血液学分会,中国抗癌协会淋巴瘤专业委员会.中国弥漫大B细胞淋巴瘤诊断与治疗指南(2013年版)[J].中华血液学杂志,2013,34(9):816-9.
[3]应志涛,朱军.治疗中期PET/CT评估在弥漫大B细胞淋巴瘤中的预后意义[J].循证医学,2012,12(5):259-61.
[4]李洪生,吴湖炳,王全师,等.18F-FDG PET/CT评价弥漫性大B细胞淋巴瘤化疗中期的治疗反应[J].中华核医学杂志,2011,31(3):145-50.
[5]李小秋,李甘地,高子芬,等.中国淋巴瘤亚型分布:国内多中心性病例10002例分析[J].诊断学理论与实践,2012,11(2):111-5.
[6]朱军.淋巴瘤化疗及放疗进展[J].中国全科医学,2002,5(5):350-1.
[7]Ngeow JY,Quek RH,Ng DC,et al.High SUV uptake on FDGPET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG-PET/CT staging in lymphoma[J].Ann Oncol,2009,20(9):1543-7.
[8]周吉成.非霍奇金淋巴瘤治疗现状[J].广西医学,2005,27(10):1508-9.
[9]Weiler-Sagie M,Bushelev O,Epelbaum R,et al.(18)F-FDG avidity in lymphoma readdressed:a study of 766 patients[J].J Nucl Med,2010,51(1):25-30.
[10]Spaepen K,Stroobants S,Dupont P,et al.(18)[F]FDG PET monitoring of tumour response to chemotherapy:does[(18)F]FDG uptake correlate with the viable tumour cell fraction[J].Eur J Nucl Med Mol Imaging,2003,30(5):682-8.
[11]Thomas A,Gingrich RD,Smith BJ,et al.18-Fluoro-deoxyglucose positron emission tomography report interpretation as predictor of outcome in diffuse large B-cell lymphoma including analysis of`indeterminate'reports[J].Leuk Lymphoma,2010,51(3):439-46.
[12]应志涛,王雪鹃,宋玉琴,等.弥漫大B细胞淋巴瘤患者规范治疗后行18F-FDG PET/CT检查的预后意义[J].中华血液学杂志,2012,33(10):810-3.
[13]王全师,吴湖炳,王明芳,等.18F-FDG显像对淋巴瘤分期及疗效评价的价值[J].中华核医学杂志,2004,24(1):8-10.
[14]Spaepen K,Stroobants S,Dupont P,et al.Early restaging positron emission tomography with(18)F-fluorodeoxyglucose predicts outcome in patients with aggressive non-Hodgkin's lymphoma[J].Ann Oncol,2002,13(9):1356-63.
[15]Cheson BD,Pfistner B,Juweid ME,et al.Revised response criteria for malignant lymphoma[J].J Clin Oncol,2007,25(5):579-86.
[16]Moskowitz CH,Schoeder H,Teruya-Feldstein JA,et al.Riskadapted dose-dense immunochemotherapy determined by interim FDG-PET in advanced-stage diffuse large B-cell lymphoma[J].J Clin Oncol,2010,28(11):1896-903.
[17]Horning SJ,Juweid ME,Schder H,et al.Interim positron emission tomography scans in diffuse large B-cell lymphoma:an Independent expert nuclear medicine evaluation of the Eastern Cooperative Oncology Group E3404 study[J].Blood,2010,115(4):775-7;quiz 918.
[18]Itti E,Juweid ME,Haioun C,et al.Improvement of early18F-FDG PET interpretation in diffuse large B-cell lymphoma:importance of the reference background[J].J Nucl Med,2010,51(12):1857-62.