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结外NK/T细胞淋巴瘤治疗前正电子发射计算机断层扫描显像中骨髓 18F-脱氧葡萄糖摄取形态预测预后的价值

Prognostic value of bone marrow 18F-FDG uptake pattern of pretreatment PET-CT in extranodal NK/T cell lymphoma

摘要:

目的:探讨初诊结外NK/T细胞淋巴瘤(ENKTL)治疗前 18F-脱氧葡萄糖( 18F-FDG)正电子发射计算机断层扫描(PET-CT)显像中骨髓摄取形态预测预后的价值。 方法:回顾性分析63例Ⅱ~Ⅳ期ENKTL患者的临床病理资料,全组患者治疗前均行骨髓活检和 18F-FDG PET-CT检查。以正常肝脏组织 18F-FDG摄取为标准,将患者分为骨髓 18F-FDG摄取增高局灶型、弥漫型和摄取正常型。采用Kaplan-Meier法和log rank检验进行单因素生存分析,多因素生存分析采用Cox比例风险模型。 结果:63例患者中,PET-CT显像中骨髓 18F-FDG摄取正常型22例,骨髓 18F-FDG摄取增高弥漫型24例,骨髓 18F-FDG摄取增高局灶型17例。骨髓活检诊断骨髓浸润阴性55例,阳性8例。63例患者中,复发进展37例,死亡31例。骨髓 18F-FDG摄取增高局灶型和正常型患者的3年无进展生存率分别为14.7%和63.6%( P=0.006),3年总生存率分别为18.8%和64.8%( P=0.005)。骨髓 18F-FDG摄取增高弥漫型和正常型患者的3年无进展生存率分别为35.3%和63.6%( χ2=1.968, P=0.161),3年总生存率分别为47.9%和64.8%( P=0.280)。单因素生存分析结果示,乳酸脱氢酶、EB病毒(EBV)DNA、韩国预后指数、骨髓 18F-FDG摄取形态均与患者的无进展生存和总生存有关(均 P<0.05);多因素生存分析结果示,EBV-NDA、骨髓 18F-FDG摄取形态为影响患者无进展生存的独立危险因素(均 P<0.05),EBV-DNA是影响患者总生存的独立危险因素( P<0.05)。 结论:ENKTL患者治疗前 18F-FDG PET-CT显像中骨髓摄取形态对患者预后评估具有一定的价值,骨髓 18F-FDG摄取增高局灶型是影响患者无进展生存的独立危险因素。

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abstracts:

Objective:To investigate the prognostic value of bone marrow (BM) 18F-fluorodeoxyglucose ( 18F-FDG) uptake pattern of pretreatment positron emission tomography/computed tomography (PET-CT) in extranodal NK/T cell lymphoma (ENKTL) patients. Methods:We retrospectively collected clinical data from a series of 63 ENKTL patients with stageⅡ~Ⅳ, who have received both 18F-FDG PET-CT and bone marrow biopsy (BMB) prior to treatment. According the BM 18F-FDG uptake pattern of PET-CT, the patients were divided into three groups: focal BM FDG uptake higher than liver (fPET+ ), diffuse BM uptake higher than liver (dPET+ ) and normal BM uptake (lower than liver) (nPET). The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis, and COX proportional hazards model for multivariate analysis. Results:Among the 63 patients, 22 patients had nPET, 24 patients showed dPET+ , and 17 patients had fPET+ . BMB positive was found in 8 patients, and negative in 55 patients. Thirty-seven patients had disease progression or relapse, and 31 patients died. The 3-years progression free survival (3y-PFS) rates of fPET+ patients and nPET patients were 14.7% and 63.6% ( P=0.006). The 3-years overall survival (3y-OS) rates were 18.8% and 64.8% ( P=0.005). The 3y-PFS of dPET+ patients and nPET patients were 35.6% and 63.6% ( P=0.161), 3y-OS were 47.9% and 64.8% ( P=0.280). Univariate analysis showed that lactate dehydrogenase (LDH) level, Epstein-Barr virus DNA (EBV-DNA), Korean prognostic index (KPI) and BM 18F-FDG were related with PFS and OS (all P<0.05). Multivariate analysis showed EBV-DNA and BM 18F-FDG were independent predictors for PFS ( P<0.05). EBV-DNA was also an independently predictor for OS ( P<0.05). Conclusions:PET/CT-directed BM patterns are meaningful in predicting prognosis of newly diagnosed ENKTL patients. Focal BM 18F-FDG uptake pattern is an independent predictor for PFS.

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