-
弥漫大B细胞淋巴瘤(diffuse large cell lym-phoma,DLBCL)患者约占我国非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)患者总数的37.94%[1],是最常见的侵袭性NHL。大部分DLBCL患者可以被治愈,但其临床及病理异质性较大,不同患者的疗效和预后有差异,因此如何准确评价疗效及预后具有重要意义。
PET/CT与临床预后因素在弥漫大B细胞淋巴瘤疗效评价及预后评估中的应用
Application of PET/CT and clinical factors in the therapeutic and prognostic evaluation of diffuse large B cell lymphoma
-
摘要: 弥漫大B细胞淋巴瘤(DLBCL)是最常见的侵袭性非霍奇金淋巴瘤(NHL)。应用美罗华联合环磷酰胺、阿霉素、长春新碱、甲泼尼龙化疗方案后,DLBCL患者的治愈率可达60%~80%。由于DLBCL在分子病理等方面具有明显的异质性,不同患者的疗效和预后不同,因此如何正确评价其疗效及预后是目前研究的热点。18F-FDG PET/CT是DLBCL患者常用的疗效评价及预后评估的影像学工具。国际预测预后指数(IPI)以及美国国立综合癌症网络-国际预后指标(NCCN-IPI)是广泛应用于临床的恶性淋巴瘤预后评分系统。近年来,一些新的临床及分子病理因素的预后价值也先后被探索。笔者将对PET/CT、临床预后评分系统、不同的临床及分子病理预后因素在DLBCL患者的疗效评价及预后评估中的应用、研究进展以及发展趋势进行综述。
-
关键词:
- 淋巴瘤 /
- B细胞 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 标准化摄取值 /
- 疗效评价 /
- 预后
Abstract: Diffuse large B-cell lymphoma(DLBCL) is a common aggressive non-Hodgkin lymphoma(NHL). When rituximab combined with cyclophosphamide, doxorubicin, vincristine, and methylprednisolone chemotherapy regimen is applied, the cure rate of DLBCL patients can reach 60%-80%. However, DLBCL possesses prominent heterogeneity of molecular pathology, and different patients have different efficacies and prognoses. Therefore, the correct evaluation of efficacy and prognosis is the focus of the current study. 18F-FDG PET/CT is an imaging tool commonly used for DLBCL patients during therapeutic and prognostic evaluation. The international prognostic index(IPI) and the national comprehensive cancer network-international prognostic index (NCCN-IPI) are widely used clinical prognostic scoring systems for malignant lymphoma. Recently, the prognostic value of a number of new clinical and molecular pathological factors has been explored. This study reviews the application, research progress, and development trend of PET/CT, clinical prognostic score system, different clinical and molecular pathologic prognostic factors during treatment evaluation, and prognosis of DLBCL patients. -
[1] 李小秋, 李甘地, 高子芬, 等.中国淋巴瘤亚型分布:国内多中心性病例10002例分析[J].诊断学理论与实践, 2012, 11(2):111-115. D0I:10.3969/i.issn.1671-2870.2012.02.006.
Li XQ, Li GD, Gao ZF, et al. Distribution pattern of lymphoma subtypes in China:A nation wide multicenter study of 10002 cases[J]. J Diagn Concepts Pract, 2012, 11(2):111-115.[2] Cheson BD, Horning SJ, Coiffier B, et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas[J]. J Clin Oncol, 1999, 17(4):1244-1253. DOI:10.1200/JCO.1999.17.4.1244. [3] Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma:consensus of the imaging subcommittee of international harmonization project in lymphoma[J]. J Clin Oncol, 2007, 25(5):571-578. DOI:10.1200/JCO.2006.08.2305. [4] Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma[J]. J Clin Oncol, 2007, 25(5):579-586.DOI:10.1200/JCO.2006.09.2403. [5] Meignan M, Gallamini A, Meignan M, et al. Report on the first international workshop on interim-PET-scan in lymphoma[J]. Leuk Lymphoma, 2009, 50(8):1257-1260. DOI:10.1080/10428190903040048. [6] Barrington SF, Mikhaeel NG, Kostakoglu L, et al. Role of imaging in the staging and response assessment of lymphoma:consensus of the International Conference on Malignant Lymphomas Imaging Working Group[J]. J Clin Oncol, 2014, 32(27):3048-3058. DOI:10.1200/JCO.2013.53.5229. [7] Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma:the Lugano classification[J]. J Clin Oncol, 2014, 32(27):3059-3068. DOI:10.1200/JCO.2013.54.8800. [8] Fallanca F, Alongi P, Incerti E, et al. Diagnostic accuracy of FDG PET/CT for clinical evaluation at the end of treatment of HL and NHL:a comparison of the Deauville Criteria (DC) and the International Harmonization Project Criteria (IHPC)[J]. Eur J Nucl Med Mol Imaging, 2016, 43(10):1837-1848. DOI:10.1007/s00259-016-3390-9. [9] Nols N, Mounier N, Bouazza S, et al. Quantitative and qualitative analysis of metabolic response at interim positron emission tomography scan combined with International Prognostic Index is highly predictive of outcome in diffuse large B-cell lymphoma[J].Leuk Lymphoma, 2014, 55(4):773-780. DOI:10.3109/10428194. 2013.831848. [10] Itti E, Meignan M, Berriolo-Riedinger A, et al. An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma:comparison between Deauville criteria and △SUVmax[J]. Eur J Nucl Med Mol Imaging, 2013, 40(9):1312-1320. DOI:10.1007/s00259-013-2435-6. [11] Safar V, Dupuis J, Itti E, et al. Interim[18F]fluorodeoxy glucose positron emission tomography scan in diffuse large B-cell lymphoma treated with anthracycline-based chemotherapy plus rituximab[J]. J Clin Oncol, 2012, 30(2):184-190. DOI:10.1200/JCO.2011. 38. 2648. [12] Casasnovas RO, Meignan M, Berriolo-Riedinger A, et al. SUVmax reduction improves early prognosis value of interim positron emission tomography scans in diffuse large B-cell lymphoma[J].Blood, 2011, 118(1):37-43. DOI:10.1182/blood-2010-12-327767. [13] Minamimoto R, Fayad L, Advani R, et al. Diffuse large B-Cell lymphoma:prospective multicenter comparison of early interim FLT PET/CT versus FDG PET/CT with IHP, EORTC, deauville, and PERCIST criteria for early therapeutic monitoring[J]. Radiology, 2016, 280(1):220-229. DOI:10.1148/radiol.2015150689. [14] Shen G, Ma H, Pang F, et al.Correlations of 18F-FDG and 18F-FLT uptake on PET with Ki-67 expression in patients with lung cancer:a meta-analysis[J/OL]. Acta Radiologica, 2017:284185117706609.[2017-05-06]. http://journals.sagepub.com/doi/pdf/10.1177/0284185117706609.[published online ahead of print May 5, 2017]. DOI:10.1177/0284185117706609. [15] Mylam KJ, El-Galaly TC, Hutchings M, et al. Prognostic impact of clinician-based interpretation of 18F-fluorodeoxyglucose positron emission tomography/computed tomography reports obtained in patients with newly diagnosed diffuse large B-cell lymphoma[J]. Leuk Lymphoma, 2014, 55(7):1563-1569. DOI:10.3109/10428194. 2013.850165. [16] 丁重阳, 李天女, 孙晋, 等.化疗中期及终末期18F-FDG PET/CT显像对弥漫性大B细胞淋巴瘤患者预后评估价值[J].中华核医学与分子影像杂志, 2014, 34(6):461-465. DOI:10.3760/cma.j.issn.2095-2848.2014.06.010.
Ding CY, Li TN, Sun J, et al. Prognostic value of interim and post-therapy 18F-FDG PET/CT in pafients with diffuse large b-cell lymphoma[J]. Chin J Nucl Med Mol Imaging, 2014, 34(6):461-465. doi: 10.3760/cma.j.issn.2095-2848.2014.06.010[17] 胡娜, 吴永港, 肖立志, 等. 18F-FDG PET/CT代谢活性参数及其在淋巴瘤中的应用[J].国际放射医学核医学杂志, 2015, 39(4):342-347. DOI:10.3760/cma.j.issn.1673-4114.2015.04.015.
Hu N, Wu YG, Xiao LZ, et al. Metabolic parameters of 18F-FDG PET/CT and their application in lymphoma[J]. Int J Radiat Med Nucl Med, 2015, 39(4):342-347. doi: 10.3760/cma.j.issn.1673-4114.2015.04.015[18] Sasanelli M, Meignan M, Haioun C, et al. Pretherapy metabolic tumour volume is an independent predictor of outcome in patients with diffuse large B-cell lymphoma[J]. Eur J Nucl Med Mol Imaging, 2014, 41(11):2017-2022. DOI:10.1007/s00259-014-2822-7. [19] Gallicchio R, Mansueto G, Simeon V, et al. F-18 FDG PET/CT quantization parameters as predictors of outcome in patients with diffuse large B-cell lymphoma[J]. Eur J Haematol, 2014, 92(5):382-389. DOI:10.1111/ejh.12268. [20] Xie M, Wu K, Liu Y, et al. Predictive value of F-18 FDG PET/CT quantization parameters in diffuse large B cell lymphoma:a meta-analysis with 702 participants[J]. Med Oncol, 2015, 32(1):446.DOI:10.1007/s12032-014-0446-1. [21] Ceriani L, Martelli M, Conconi A, et al. Prognostic models for primary mediastinal (thymic) B-cell lymphoma derived from 18F-FDG PET/CT quantitative parameters in the International Extranodal Lymphoma Study Group (IELSG) 26 study[J]. Br J Haematol, 2017, 178(4):588-591. DOI:10.1111/bjh.14728. [22] International Non-Hodgkin's Lymphoma Prognostic Factors Project.A predictive model for aggressive non-Hodgkin's lymphoma[J]. N Engl J Med, 1993, 329(14):987-994. DOI:10.1056/NEJM1993099303291402. [23] Sehn Lh, Berry B, Chhanabhai M, et al. The revised International Prognostic Index(R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP[J]. Blood, 2007, 109(5):1857-1861. DOI:10.1182/blood-2006-08-038257. [24] Zhou Z, Sehn LH, Rademaker AW, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era[J]. Blood, 2014, 123(6):837-842. DOI:10.1182/blood-2013-09-524108. [25] 宋腾, 王华庆, 张会来, 等.改良国际预后指数(NCCN-IPI)对R-CHOP方案治疗弥漫大B细胞淋巴瘤的预后评估(附168例临床分析)[J].中国肿瘤临床, 2015, 42(21):1050-1055. DOI:10.3969/j.issn.1000-8179.2015.21.977.
Song T, Wang HQ, Zhang HL, et al. Prognostic significance of an enhanced International Prognostic Index(NCCN-IPI) for patients with diffuse large B-cell lymphoma treated with R-CHOP:a case report of 168 patients[J]. Chin J Clin Oncol, 2015, 42(21):1050-1055. doi: 10.3969/j.issn.1000-8179.2015.21.977[26] Melchardt T, Troppan K, Weiss L, et al. A modified scoring of the NCCN-IPI is more accurate in the elderly and is improved by albumin and β2-microglobulin[J]. Br J Haematol, 2015, 168(2):239-245. DOI:10.1111/bjh.13116. [27] Altan M, Haberal HB, Akdogan B, et al. A critical prognostic analysis of neutrophil-lymphocyte ratio for patients undergoing nephroureterectomy due to upper urinary tract urothelial carcinoma[J]. Int J Clin Oncol, 2017, 22(5):964-971. DOI:10.1007/s10147-017-1150-x. [28] Huang Y, Feng JF, Liu JS, et al. Prognostic role of serum C-reactive protein in esophageal cancer:a systematic review and meta-analysis[J]. Ther Clin Risk Manag, 2015, 11:89-94. DOI:10.2147/TCRM.S70954. [29] Panizo C, Rodríguez AJ, Gutiérrez G, et al. Evaluation of clinical and biological prognostic factors in relapsed or refractory diffuse large B-cell lymphoma patients after previous treatment with rituximab and chemotherapy:results of the PRO-R-IPI study[J]. Clin Lymphoma Myeloma Leuk, 2015, 15(7):398-403. DOI:10. 1016/j.clml.2015.02.029. [30] Wang J, Zhou X, Liu Y, et al.Prognostic significance of neutrophil-to-lymphocyte ratio in diffuse large B-cell lymphoma:A meta-analysis[J/OL]. PLoS One, 2017, 12(4):e0176008[2017-05-01].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404792/pdf/pone.0176008.pdf.DOI:10.1371/journal.pone.0176008. [31] Herishanu Y, Perry C, Braunstein R, et al. Early-mid treatment C-reactive protein level is a prognostic factor in aggressive non-Hodgkin's lymphoma[J]. Eur J Haematol, 2007, 79(2):150-154.DOI:10.1111/j.1600-0609.2007.00894.x. [32] Troppan KT, Schlick K, Deutsch A, et al. C-reactive protein level is a prognostic indicator for survival and improves the predictive ability of the R-IPI score in diffuse large B-cell lymphoma patients[J]. Br J Cancer, 2014, 111(1):55-60. DOI:10.1038/bjc.2014.277. [33] Wang J, Zhou M, Wang X, et al. Pretreatment C-reactive protein was an Independent prognostic factor for patients with diffuse large B-cell lymphoma treated with RCHOP[J]. Clin Chim Acta, 2016, 459(459):150-154. DOI:10.1016/j.cca.2016.05.033. [34] Kanemasa Y, Shimoyama T, Sasaki Y, et al. Analysis of prognostic value of complete response by PET-CT and further stratification by clinical and biological markers in DLBCL patients[J]. Med Oncol, 2017, 34(2):29. DOI:10.1007/s12032-017-0885-6. [35] Kawamoto K, Miyoshi H, Yoshida N, et al. MYC translocation and/or BCL 2 protein expression are associated with poor prognosis in diffuse large B-cell lymphoma[J]. Cancer Sci, 2016, 107(6):853-861. DOI:10.1111/cas.12942. [36] Petrella T, Copie-Bergman C, Brière J, et al. BCL2 expression but not MYC and BCL2 coexpression predicts survival in elderly patients with diffuse large B-cell lymphoma independently of cell of origin in the phase 3 LNH03-6B trial[J]. Ann Oncol, 2017, 28(5):1042-1049. DOI:10.1093/annonc/mdx022. [37] Bari A, Marcheselli L, Marcheselli R, et al. Absolute monocyte count at diagnosis could improve the prognostic role of early FDG-PET in classical Hodgkin lymphoma patients[J]. Br J Haematol, 2016. DOI:10.1111/bjh.14406. [38] Kong Y, Qu L, Li Y, et al. Predictive significance of a new prognostic score for patients with diffuse large B-Cell lymphoma in the Interim-Positron emission tomography findings[J/OL]. Medicine(Baltimore), 2016, 95(6):e2808[2017-03-01]. http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC4753946&blobtype=pdf. DOI:10.1097/MD.0000000000002808. [39] Adams HJ, Nievelstein RA, Kwee TC. Prognostic value of complete remission status at end-of-treatment FDG-PET in R-CHOP-treated diffuse large B-cell lymphoma:systematic review and meta-analysis[J]. Br J Haematol, 2015, 170(2):185-191. DOI:10.1111/bjh.13420.
计量
- 文章访问数: 4081
- HTML全文浏览量: 3181
- PDF下载量: 6