目的 探讨治疗前18 F-脱氧葡萄糖(18 F-FDG)PET/CT显像代谢参数对Ⅰ ~ Ⅱ期结外自然杀伤/T细胞淋巴瘤(ENKTL)的预后价值.方法 回顾性分析2010年8月至2018年4月间南京医科大学第一附属医院67例Ⅰ~ Ⅱ期ENKTL患者(男47例、女20例,中位年龄57岁)的临床资料及治疗前18 F-FDG PET/CT显像资料.以最大标准摄取值(SUVmax)的40%作为阈值,获得全身肿瘤的SUVmax、代谢体积(MTV)和病灶糖酵解总量(TLG),采用受试者工作特征曲线(ROC)分析判断三者预测无进展生存(PFS)和总生存(OS)的最佳阈值.采用Kaplan-Meier法、log-rank检验及Cox比例风险回归模型分析数据.结果 67例ENKTL患者的SUVmax、MTV及TLG分别为12.32(8.65,16.96)、13.13(7.37,22.74)ml和92.17(46.54,198.46).ROC曲线分析显示,三者判断PFS的阈值分别为13.09、18.05 ml和152.81.单因素分析中,B症状、乳酸脱氢酶(LDH)、β2微球蛋白、美国东部肿瘤协作组(ECOG)评分、韩国预后指数(KPI)、SUVmax、MTV、TLG及治疗模式(单纯化疗/放化疗联合治疗)是患者PFS率的影响因素(χ2值:5.466~27.163,均P<0.05);B症状、LDH、β2微球蛋白、EB病毒(EBV)-DNA、超腔、ECOG评分、KPI、MTV、TLG和治疗模式是患者OS率的影响因素(χ2值:4.022~34.774,均P<0.05);SUVmax与OS率无关(χ2=2.766,P>0.05).多因素分析中,ECOG评分、MTV和TLG是影响患者PFS率的独立危险因素[相对危险度(RR):5.107~6.802,均P<0.05];ECOG评分、MTV、TLG和治疗模式是影响患者OS率的独立危险因素(RR:0.221~9.106,均P<0.05).结论治疗前18 F-FDG PET/CT显像测得的MTV和TLG是影响Ⅰ ~ Ⅱ期ENKTL患者PFS及OS的独立预后因素,两者预测价值优于SUVmax.
Objective To investigate the prognostic value of metabolic parameters calculated from pretreatment 18 F-fluorodeoxyglucose (FDG) PET/ CT images in patients with extranodal natural killer/ T cell lymphoma (ENKTL) of stage Ⅰ-Ⅱ. Methods From August 2010 to April 2018, 67 patients with ENKTL of stage Ⅰ-Ⅱ disease (47 males, 20 females; median age 57 years) in the First Affiliated Hospital of Nanjing Medical University were enrolled, and the clinic data and pretreatment 18 F-FDG PET/ CT imaging data were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of tumor tissue were calculated from PET/ CT images with the threshold value of 40% of maximum standardized uptake value (SUVmax ). The optimal cut-off values of progression-free survival (PFS) and overall survival (OS) of SUVmax , MTV and TLG were investigated by using receiver operating characteristic (ROC) curve analysis. Kaplan-Meier method, log-rank test and Cox proportional hazards model were used for data analy-sis. Results SUVmax , MTV and TLG of 67 patients were 12.32(8.65, 16.96), 13.13(7.37, 22.74) ml, 92.17(46.54, 198.46), respectively. ROC curve analysis showed that the cut-off values of SUVmax , MTV and TLG were 13.09, 18.05 ml and 152.81, respectively. Univariate analysis showed that B symptoms, lac-tate dehydrogenase (LDH) level, β2-microglobulin, Eastern Cooperative Oncology Group (ECOG) score, Korean prognostic index (KPI), SUVmax , MTV, TLG and treatment mode (chemotherapy or chemoradio-therapy) were relative factors affecting PFS (χ2: 5.466-27.163, all P<0.05). B symptoms, LDH level,β2-microglobulin, EB virus (EBV)-DNA, extra-cavitary extension, ECOG score, KPI, MTV, TLG and treatment mode were relative factors affecting OS (χ2: 4.022-34.774, all P<0.05). SUVmax was not the in-fluencing factor of OS(χ2 = 2.766, P>0.05). Multivariate analysis showed that ECOG score, MTV and TLG were independent prognostic predictors of PFS (relative ratio (RR): 5.107- 6.802, all P< 0.05), and ECOG score, MTV, TLG and treatment mode were independent prognostic predictors of OS (RR: 0.221-9. 106, all P<0.05). Conclusions MTV and TLG from pretreatment 18 F-FDG PET/ CT images are inde-pendent prognostic factors for PFS and OS in patients with ENKTL of stage Ⅰ-Ⅱ. MTV and TLG may be more useful than SUVmax for prognosis.