Prognostic value of 18F-FDG PET/CT imaging and related factors for patients with classic Hodgkin lymphoma before or after autologous stem cell transplantation

中华核医学与分子影像杂志 Pub Date : 2020-03-25 DOI:10.3760/CMA.J.CN321828-20190729-00149

Wenli Qiao, Jiahua Niu, Wenya Jin, Y. Xing, Tai-song Wang, Jian-hua Song, Jinhua Zhao

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Abstract

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. Key words: Lymphoma; Stem Cells; Transplantation, autologous; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

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18F-FDG PET/CT显像及相关因素对经典霍奇金淋巴瘤患者自体干细胞移植前后预后的价值

目的评价18F-氟脱氧葡萄糖（FDG）PET/CT显像及相关因素对经典霍奇金淋巴瘤（cHL）患者自体干细胞移植（ASCT）前后预后的预测价值。方法回顾性分析2008年1月至2017年6月在上海总医院经病理证实的55例cHL患者（男28例，女27例，年龄（28.8±9.6）岁）。43例患者在ASCT前进行18F-FDG PET/CT成像，34例患者在ASCT后进行18F-FDG PET/CT成像（22例患者同时在ASCT前后进行了成像）。根据多维尔5分量表18F-FDG PET/CT成像结果，将患者分为阳性组（≥4）和阴性组（<4）。使用Kaplan-Meier生存分析和log秩检验，用无进展生存期（PFS）和总生存期（OS）评估相关因素对预后的预测价值。采用Cox回归模型计算危险比。结果55例cHL患者中，29例（53%）患者在中位随访8个月后病情进展，11例（20%）患者在中位数随访29.5个月后死亡，3年PFS率为46.4%，OS率为84.5%，在国际预后评分（IPS）为0-2的患者和IPS为3-7的患者之间，在具有不同挽救化疗效果（完全缓解（CR）、部分缓解（PR）+稳定疾病（SD）、进行性疾病（PD））的患者中，ASCT前后PET/CT阴性或阳性的患者之间（χ2值：5.52-2001，HR:2.21（95%CI:1.56-3.12）-5.51（95%CI:1.86-16.33），均P<0.05），ASCT前后18F-FDG PET/CT联合显像预测PFS具有统计学意义（χ2=11.28，P<0.01）。多因素生存分析显示，ASCT后PET/CT结果阳性患者的进展风险显著高于阴性患者（HR=6.20，P<0.01），结论ASCT后18F-FDG PET/CT显像结果对预测ASCT后cHL患者的PFS具有重要价值，B症状可作为ASCT后OS的重要预后指标。关键词：淋巴瘤；干细胞；自体移植；正电子发射断层扫描；层析成像，X射线计算机；脱氧葡萄糖

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来源期刊

中华核医学与分子影像杂志核医学，分子影像

自引率

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发文量

5088

期刊介绍： Chinese Journal of Nuclear Medicine and Molecular Imaging (CJNMMI) was established in 1981, with the name of Chinese Journal of Nuclear Medicine, and renamed in 2012. As the specialized periodical in the domain of nuclear medicine in China, the aim of Chinese Journal of Nuclear Medicine and Molecular Imaging is to develop nuclear medicine sciences, push forward nuclear medicine education and basic construction, foster qualified personnel training and academic exchanges, and popularize related knowledge and raising public awareness. Topics of interest for Chinese Journal of Nuclear Medicine and Molecular Imaging include: -Research and commentary on nuclear medicine and molecular imaging with significant implications for disease diagnosis and treatment -Investigative studies of heart, brain imaging and tumor positioning -Perspectives and reviews on research topics that discuss the implications of findings from the basic science and clinical practice of nuclear medicine and molecular imaging - Nuclear medicine education and personnel training - Topics of interest for nuclear medicine and molecular imaging include subject coverage diseases such as cardiovascular diseases, cancer, Alzheimer’s disease, and Parkinson’s disease, and also radionuclide therapy, radiomics, molecular probes and related translational research.