The prognostic value of positron emission tomography/computed tomography in rheumatoid arthritis patients with methotrexate-associated lymphoproliferative disorders
The prognostic value of positron emission tomography/computed tomography in rheumatoid arthritis patients with methotrexate-associated lymphoproliferative disorders
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DOI：
10.1007/s00277-018-3327-4
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发表时间：
2018-09-01
影响因子：
3.5
通讯作者：
Mori, Takehiko
中科院分区：
文献类型：
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作者：
Takanashi, Satoshi;Nakazato, Tomonori;Mori, Takehiko
近年来，在类风湿性关节炎（RA）中发现甲氨蝶呤相关淋巴组织增生性疾病（MTX LPDs）常与医源性免疫缺陷相关。据报道，有几个因素与预后有关。我们在此研究18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在预测MTX-LPD预后中的有效性。我们对2004年至2015年接受治疗的18例MTX-LPD患者的临床特征、特征和结局进行了回顾性分析。所有患者均根据活检组织学检查确诊为MTX-LPD。18例中有5例（28%）在停止MTX后检测到自发消退。PET/CT上FDG摄取的最大标准化摄取值（SUVmax）显著较低，LPD相关肿瘤的最大尺寸在显示自发消退的患者中显著较小（分别为p = 0.01，p = 0.04）。SUVmax和最大肿瘤大小均与较好的总生存率相关（分别为p = 0.02，p = 0.04）。因此，PET/CT可用于预测MTX/LPD诊断时的自发消退和预后。自发消退的病例在随访期间从未复发，尽管使用了几种抗类风湿关节炎药物，包括生物制剂。早期发现LPDs和早期停用MTX对RA患者的管理至关重要。通过F-FDG-PET/CT评估可用于预测自发消退和预后。
Recently, methotrexate-associated lymphoproliferative disorders (MTX-LPDs) in rheumatoid arthritis (RA) have been found to commonly occur in association with iatrogenic immunodeficiency. Several factors have been reported to be related to the prognosis. We herein investigate the efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the prognosis of MTX-LPD. We performed a retrospective analysis of the clinical features, characteristics, and outcomes of 18 patients with MTX-LPDs who were treated from 2004 to 2015. All of the patients were diagnosed with MTX-LPD based on the histological examination of biopsy specimens. Spontaneous regression was detected after the cessation of MTX in 5 of 18 cases (28%). The maximum standardized uptake value (SUVmax) of the FDG uptake on PET/CT was significantly lower, and the maximum size of the LPD-associated tumor was significantly smaller among the patients who showed spontaneous regression (p = 0.01, p = 0.04, respectively). Both the SUVmax and the maximum tumor size were related to better overall survival (p = 0.02, p = 0.04, respectively). Thus, PET/CT can be used to predict spontaneous regression and the prognosis at the diagnosis of MTX/LPD. Cases that showed spontaneous regression never relapsed during the follow-up period, despite the usage of several anti-rheumatoid arthritis drugs, including biological agents. The early detection of LPDs and the early cessation of MTX are important for the management of RA patients. An evaluation by F-FDG-PET/CT can be useful for predicting spontaneous regression and the prognosis.