基线18F-FDG PET/CT 在结外自然杀伤/T 细胞淋巴瘤患者预后评估中的价值

目的 探讨结外自然杀伤/T细胞淋巴瘤（ENKTL）患者治疗前18F-氟脱氧葡萄糖（FDG）PET/CT代谢参数在其预后评估中的价值。 方法 回顾性分析37例在南京大学医学院附属鼓楼医院确诊为ENKTL患者的临床资料，其中男性27例、女性10例，中位年龄46（21~76）岁。根据患者不同生存状态分为无进展组、进展组和生存组、病死组。所有患者行PET/CT显像，测量各组患者的最大标准化摄取值（SUV_max），并以SUV>40% SUV_max的体素边界作为临界值，分别测量全身肿瘤代谢体积（MTV）和全身病灶糖酵解总量（TLG）。采用Mann-Whitney U检验评估2组的PET参数差异。应用受试者工作特征（ROC）曲线获得SUV_max、全身MTV和全身TLG的最佳临界值，根据PET参数最佳临界值将患者重新分为以临界值为界的不同组。采用Kaplan-Meier法及Log-rank检验预测2组间总生存期（OS）和无进展生存期（PFS）的差异。采用单因素分析法评估PET参数和临床变量的预后意义。采用Cox比例风险模型评估PET参数是否为OS和PFS的独立预后危险因素。 结果 无进展组的SUV_max、全身MTV和全身TLG的M（P₂₅，P₇₅）分别为10.8（6.9，14.4）、13.1（7.0，16.7）cm3和53.81（34.1，97.4），进展组分别为11.7（9.5，17.8）、29.4（17.3，69.2）cm3和183.5（125.1，725.3）。进展组的SUV_max、全身MTV和全身TLG均高于无进展组，且差异均有统计学意义（Z=?2.60、?3.28、?3.25，均P<0.01）。生存组的SUV_max、全身MTV和全身TLG的M（P₂₅，P₇₅）分别为9.9（6.7，12.7）、10.2 （6.7，17.1）cm3和52.4（33.4，90.4），病死组分别为12.3（9.9，18.7）、25.5（13.4，113.6 ）cm3和187.8（110.0，1006.9）。病死组的SUV_max、全身MTV和全身TLG均高于生存组，且差异均有统计学意义（Z=?3.37、?3.11、?3.76，均P<0.01）。SUV_max、全身MTV和全身TLG以临界值为界的不同组患者OS的差异均有统计学意义（χ2=5.12、13.07、15.51，均P<0.05）；全身MTV和全身TLG以临界值为界的不同组的患者PFS的差异均有统计学意义（χ2=17.55、16.21，均P<0.05）。ROC曲线分析结果显示，SUV_max、全身MTV和全身TLG的最佳临界值分别为9.03、19.17 cm3和99.95。单因素分析结果表明，韩国预后指数评分>2分、Ann Arbor分期Ⅲ/Ⅳ期、SUV_max>9.03、全身MTV>19.17 cm3和全身TLG>99.95是OS的预后危险因素，Ann Arbor分期Ⅲ/Ⅳ期、全身MTV>19.17 cm3和全身TLG>99.95是PFS的预后危险因素。多因素分析结果表明，全身MTV>19.17 cm3和全身TLG>99.95是OS和PFS的独立预后危险因素。 结论 18F-FDG PET/CT代谢参数全身MTV和全身TLG能够评估ENKTL患者的预后，而SUV_max对于ENKTL患者的预后评估价值不大。

Prognostic value of baseline 18F-FDG PET/CT in patients with extranodal NK/T-cell lymphoma

Objective To demonstrate whether 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters could predict the prognosis of patients with extranodal natural killer/T-cell lymphoma (ENKTL). Methods Thirty-seven patients, which comprise 27 males and 10 females, with a median age of 46 (21–76) years and newly diagnosed with ENKTL in Nanjing Drum Tower Hospital, were retrospectively analysed. The patients were divided into progression-free group and progression group according to their disease progression status and into survival group and death group according to their survival status. The maximum standardized uptake value (SUV_max) of each group was measured. Whole-body metabolic tumor volume (MTV) and whole-body total lesion glycolysis (TLG) were measured automatically using the threshold of 40% SUV_max. Mann-Whitney U test was used to evaluate the difference in PET parameters between groups. The optimal critical value of systemic MTV and systemic TLG was obtained by using the receiver operating characteristic curve analysis. The patients were divided into high or low groups according to the optimal critical value of PET parameters. The differences in the overall survival (OS) and progression-free survival (PFS) between groups divided by PET parameters were predicted by Kaplan-Meier method and Log-rank test. Univariate analysis was used to evaluat. Results The M (P₂₅, P₇₅) of SUV_max, whole-body MTV and whole-body TLG were 10.8 (6.9, 14.4), 13.1 (7.0, 16.7) cm3 and 53.81 (34.1, 97.4) in the progression-free group and 11.7 (9.5, 17.8), 29.4 (17.3, 69.2) cm3 and 183.5 (125.1, 725.3) in the progression group, respectively. The SUV_max, whole-body MTV and whole-body TLG of the progression group were higher than those of the progression-free group, and the difference was statistically significant (Z=?2.60, ?3.28, ?3.25; all P<0.01). The M (P₂₅, P₇₅) of SUV_max, whole-body MTV and whole-body TLG were 9.9 (6.7, 12.7), 10.2 (6.7, 17.1) cm3 and 52.4 (33.4, 90.4) in the survival group and 12.3 (9.9, 18.7), 25.5 (13.4, 113.6) cm3 and 187.8 (110.0, 1006.9) in the death group. The SUV_max, whole-body MTV and whole-body TLG of the dead group were higher than those of the survival group, and the differences were statistically significant (Z=?3.37, ?3.11, ?3.76; all P<0.01). The differences in the OS between the high and low SUV_max, whole-body MTV and whole-body TLG groups were statistically significant (χ2=5.12, 13.07, 15.51; all P<0.05). The differences in the PFS between the high and low whole-body MTV and whole-body TLG groups were statistically significant (χ2=17.55, 16.21; both P<0.05). The cut-off values for SUV_max, whole-body MTV and whole-body TLG were 9.03, 19.17 cm3 and 99.95, respectively, according to the receiver operating characteristic curve analysis. Univariate analysis showed that Ann Arbor stageⅢ/Ⅳ, Korean prognostic index score>2, SUV_max>9.03, whole-body MTV>19.17 cm3 and whole-body TLG>99.95 were associated with OS, and Ann Arbor stageⅢ/Ⅳ stage, whole-body MTV>19.17 cm3 and whole-body TLG>99.95 were associated with PFS. Multivariate analysis showed that whole-body MTV>19.17 cm3 and whole-body TLG>99.95 were independent prognostic factors of both OS and PFS.whole-body TLG>99.95 were associated with PFS. Multivariate analysis showed that whole-body MTV>19.17 cm3 and whole-body TLG>99.95 were independent prognostic factors of both OS and PFS. Conclusion The 18F-FDG PET/CT metabolic parameters whole-body MTV and whole-body MTV have remarkable prognostic value in patients with ENKTCL, whereas SUV_max has little value in prognosis prediction.