摘要
目的探讨经典霍奇金淋巴瘤(cHL)患者在自体干细胞移植(ASCT)前或后行18F-脱氧葡萄糖(FDG)PET/CT显像及相关因素的预测预后价值。方法回顾性收集2008年1月至2017年6月间在上海交通大学附属第一人民医院经病理检查证实的55例cHL患者[男28例,女27例,年龄(28.8±9.6)岁],其中43例在ASCT前、34例在ASCT后行18F-FDG PET/CT显像(22例在移植前后均行显像)。依据Deauville五分法分别将ASCT前或后PET/CT显像结果分为阳性(≥4分)和阴性组(<4分)。采用Kaplan-Meier法绘制生存曲线,分析无进展生存(PFS)和总生存(OS),并通过log-rank检验比较组间差异;通过Cox回归模型计算生存影响因素的风险比(HR)。结果55例cHL患者中,29例(53%)中位随访8个月后病情进展,11例(20%)在中位随访29.5个月后死亡;3年PFS率为46.4%,OS率为84.5%。有无B症状组间,有无纵隔大肿块组间,国际预后评分(IPS)低危组(0~2分)与高危组(3~7分)组间,挽救性化疗完全缓解(CR)、部分缓解(PR)或疾病稳定(SD)、疾病进展(PD)组间,ASCT前显像阴性与阳性组间,ASCT后显像阴性与阳性组间PFS率差异均有统计学意义[χ2值:5.52~20.01,HR:2.21(95%CI:1.56~3.12)~5.51(95%CI:1.86~16.33),均P<0.05]。有无B临床症状和有无纵隔大肿块对预测OS有统计学意义[HR=5.28(95%CI:1.14~24.51)和4.27(95%CI:1.24~14.79),均P<0.05]。ASCT前、后18F-FDG PET/CT显像结果联合对预测PFS具有统计学意义(χ2=11.28,P<0.01)。多因素分析显示ASCT后18F-FDG PET/CT显像阳性患者的进展风险明显高于显像阴性患者(HR=6.20,P<0.01);有B症状患者死亡的风险明显高于无B临床症状患者(HR=5.28,P<0.05)。结论ASCT后18F-FDG PET/CT显像结果能有效预测cHL患者ASCT后的PFS,有无B症状是预测ASCT后OS的重要指标。
Objective To assess the predictive value of 18F-fluorodeoxyglucose(FDG)PET/CT imaging and relevant factors in the prognosis of patients with classic Hodgkin lymphoma(cHL)before or after autologous stem cell transplantation(ASCT).Methods From January 2008 to June 2017,55 cHL patients(28 males,27 females;age:(28.8±9.6)years)confirmed by pathology in Shanghai General Hospital were retrospectively included.18F-FDG PET/CT imaging was performed before ASCT in 43 cases and after ASCT in 34 cases(22 patients underwent the imaging both before and after ASCT).Patients were divided into positive group(≥4)and negative group(<4)according to 18F-FDG PET/CT imaging results using Deauville 5-point scale.The predictive value of relevant factors in the prognosis was evaluated with progression-free survival(PFS)and overall survival(OS)using Kaplan-Meier survival analysis and log-rank test.Hazard ratio(HR)was calculated by Cox regression model.Results Of 55 cHL patients,29(53%)had a progression of disease after a median follow-up of 8 months,and 11(20%)patients died after a median follow-up of 29.5 months,with the 3-year PFS rate of 46.4%and OS rate of 84.5%.Significant differences of PFS rate were found between patients with or without B symptoms,between patients with or without large mediastinal mass,between patients with international prognostic score(IPS)of 0-2 and those with IPS of 3-7,among patients with different effect of salvage chemotherapy(complete remission(CR),partial remission(PR)+stable disease(SD),progressive disease(PD)),and between patients with negative or positive PET/CT imaging results before or after ASCT(χ2 values:5.52-20.01,HR:2.21(95%CI:1.56-3.12)-5.51(95%CI:1.86-16.33),all P<0.05).B symptoms and large mediastinal mass were also prognostic factors for OS rate(HR:5.28(95%CI:1.14-24.51)and 4.27(95%CI:1.24-14.79),both P<0.05).The combination of 18F-FDG PET/CT imaging before and after ASCT was statistically significant for predicting PFS(χ2=11.28,P<0.01).Multivariate survival analysis showed that the risk of progression in patients with positive PET/CT results after ASCT was significantly higher than those with negative results(HR=6.20,P<0.01),and the risk of death in patients with B symptoms was significantly higher than those without B symptoms(HR=5.28,P<0.05).Conclusion 18F-FDG PET/CT imaging results after ASCT have important values for predicting PFS in cHL patients after ASCT,and B symptoms can be used as an important prognostic indicator of OS after ASCT.
作者
乔文礼
牛家华
金文雅
邢岩
汪太松
宋建华
赵晋华
Qiao Wenli;Niu Jiahua;Jin Wenya;Xing Yan;Wang Taisong;Song Jianhua;Zhao Jinhua(Department of Nuclear Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Department of Hematology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)
出处
《中华核医学与分子影像杂志》
CAS
北大核心
2020年第3期147-152,共6页
Chinese Journal of Nuclear Medicine and Molecular Imaging
基金
上海市科学技术委员会科研计划项目(17411953200)
上海市申康医院发展中心临床科技创新项目(SHDC22015032)。
