Combined PET and Biopsy Evidence of Marrow Involvement Improves Prognostic Prediction in Diffuse Large B-Cell Lymphoma
Combined PET and Biopsy Evidence of Marrow Involvement Improves Prognostic Prediction in Diffuse Large B-Cell Lymphoma
复制标题
DOI：
10.2967/jnumed.113.134486
复制
发表时间：
2014-10-01
影响因子：
9.3
通讯作者：
Carr, Robert
中科院分区：
文献类型：
--
作者：
Cerei, Juliano J.;Gyorke, Tamas;Carr, Robert
骨髓是弥漫性大B细胞淋巴瘤（DLBCL）的重要结节部位，骨髓组织学已被纳入新的国家综合癌症网络国际预后指数。组织学上证实的骨髓受累预后差，但在更多病例中通过分期PET确定。如何结合分期PET和活检的信息来优化预后预测仍不清楚。方法：国际原子能机构赞助了一项前瞻性国际队列研究，以更好地定义PET在DLBCL中的应用。作为一项计划的辅助分析，我们研究了通过PET和活检确定的骨髓受累对临床结局的相互作用。结果：8个国家提供了327例病例，中位随访时间为35个月。无骨髓受累证据的病例（n = 231）的2年结局为81%（95%置信区间[Cl]，76%-86%）的无事件生存期（EFS）和88%（83%-91%）的总生存期（OS）; 61例仅PET确诊，81%（69%~ 89%）确诊EFS，88%（77%~ 94%）确诊OS; 10例仅活检确诊，80%（41%~ 95%）确诊EFS，100%确诊OS; PET阴性/活检阴性病例与PET阳性/活检阳性病例的风险比为2.67（95%CI，1.48-4.79）和OS的3.94（1.93-8.06）。结论：这项大型研究表明，髂嵴活检组织学阳性仅对分期PET扫描发现骨髓F-18-FDG摄取异常的患者预后不良。当髂嵴活检组织学正常时，骨髓中F-18-FDG摄取异常对结局无不良影响。
Bone marrow is an important extranodal site in diffuse large B-cell lymphoma (DLBCL), and marrow histology has been incorporated into the new National Comprehensive Cancer Network international prognostic index. Marrow involvement demonstrated histologically confers poor prognosis but is identified by staging PET in more cases. How information from staging PET and biopsy should be combined to optimize outcome prediction remains unclear. Methods: The International Atomic Energy Agency sponsored a prospective international cohort study to better define the use of PET in DLBCL. As a planned subsidiary analysis, we examined the interplay of marrow involvement identified by PET and biopsy on clinical outcomes. Results: Eight countries contributed 327 cases with a median follow-up of 35 mo. The 2-y outcomes of cases with no evidence of marrow involvement (n = 231) were 81% (95% confidence interval [Cl], 76%-86%) for event-free survival (EFS) and 88% (83%-91%) for overall survival (OS); cases identified only on PET (n = 61), 81% (69%-89%) for EFS and 88% (77%-94%) for OS; cases indentified only on biopsy (n = 10), 80% (41%-95%) for EFS and 100% for OS; or cases identified by both PET and biopsy (n = 25), 45% (25%-64%) for EFS and 55% (32%-73%) for OS. The hazard ratios for PET-negative/biopsy-negative cases versus PET-positive/biopsy-positive cases were 2.67 (95% Cl, 1.48-4.79) for EFS and 3.94 (1.93-8.06) for OS. Conclusion: This large study demonstrates that positive iliac crest biopsy histology only confers poor prognosis for patients who also have abnormal marrow F-18-FDG uptake identified on the staging PET scan. Abnormal F-18-FDG uptake in marrow, when iliac crest biopsy histology is normal, has no adverse effect on outcomes.