Prognostic significance of bone marrow infiltration detected by PET-CT in newly diagnosed diffuse large B cell lymphoma.
Prognostic significance of bone marrow infiltration detected by PET-CT in newly diagnosed diffuse large B cell lymphoma.
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PET-CT检测骨髓浸润对初诊弥漫性大B细胞淋巴瘤的预后意义
DOI：
10.18632/oncotarget.7616
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发表时间：
2016-04-05
期刊：
影响因子：
--
通讯作者：
Xu W
中科院分区：
文献类型：
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作者：
Liang JH;Sun J;Wang L;Fan L;Chen YY;Qu XY;Li TN;Li JY;Xu W
本研究的目的是检查通过基线PET-CT（PET（0）-BMI）评估的骨髓受累（BMI）在弥漫性大B细胞淋巴瘤（DLBCL）初治患者中的预后价值。2005年至2014年期间，来自单个中心的所有诊断为DLBCL的患者均从分期PET-CT（PET（0）-CT）、骨髓活检（BMB）和治疗记录中提取数据。所有PET（0）-BMI阳性（PET（0）-BMI（+））患者均行PET（3）-CT（免疫化疗第3周期后PET-CT扫描）。在169例患者中，20例（11.8%）BMB有BMI，而35例（20.7%）PET（0）-BMI阳性。在PET（0）-BMI（+）患者中，骨髓最大标准摄取值（SUVmax（BM））大于8.6的患者与IPI评分（3-5）高（P=0.002）、无进展生存期（PFS）和总生存期（OS）差（分别为P=0.025和P=0.002）显著相关。在68例IV期病例中，PET（0）-BMI阴性（PET（0）-BMI（−））患者的3年OS高于PET（0）-BMI（+）患者（84.2%±6.5% vs. 44.1%±8.6%; P=0.003），而3年PFS仅在两组之间显示出统计学显著性趋势（P=0.077）。在69例IPI（2-3）中间风险患者中，PET（0）-BMI（+）患者的PFS和OS显著低于PET（0）-BMI（-）患者（分别为P=0.009和P<0.001）。PET（0）-CT与PET（3）-CT之间SUV最大值（BM）下降百分比（Δ SUV最大值（BM））的截断值为70.0%，可预测PFS（P=0.003）和OS（P=0.023）。这些数据证实，沿着PET-CT识别骨髓的灵敏度和准确性增加，在DLBCL患者中发现了骨髓受累的新预后价值。
The aim of this study was to examine the prognostic value of bone marrow involvement (BMI) assessed by baseline PET-CT (PET(0)-BMI) in treatment-naïve patients with diffuse large B-cell lymphoma (DLBCL). All patients from a single centre diagnosed as DLBCL between 2005 and 2014 had data extracted from staging PET-CT (PET(0)-CT), bone marrow biopsy (BMB), and treatment records. The PET(3)-CT (PET-CT scan after cycle 3 of immunochemotherapy) was performed on all the patients with PET(0)-BMI positivity (PET(0)-BMI(+)). Of 169 patients, 20 (11.8%) had BMI on BMB, whereas 35 (20.7%) were PET(0)-BMI positive. Among PET(0)-BMI(+) patients, patients with maximum of standard uptake value (SUVmax) of bone marrow (SUVmax(BM)) more than 8.6 were significantly associated with high IPI score (3–5) (P=0.002), worse progression-free survival (PFS) and overall survival (OS) (P=0.025 and P=0.002, respectively). In the 68 stage IV cases, 3-year OS was higher in the patients with negative PET(0)-BMI (PET(0)-BMI(−)) than that with PET(0)-BMI(+) (84.2%±6.5% vs. 44.1%±8.6%; P=0.003), while 3-year PFS only shown a trend of statistic significance (P=0.077) between the two groups. Among the 69 patients of inter-risk of IPI (2–3), patients with PET(0)-BMI(+) had significantly inferior PFS and OS than that with PET(0)-BMI(−) (P=0.009 and P<0.001, respectively). The cut-off value of the decreased percentage of SUVmax(BM) between PET(0)-CT and PET(3)-CT (ΔSUVmax(BM)) was 70.0%, which can predict PFS (P=0.003) and OS (P=0.023). These data confirmed that along with the increased sensitivity and accuracy of identifying bone marrow by PET-CT, novel prognostic values of marrow involvement were found in patients with DLBCL.