PET/CT检查对结外自然杀伤细胞/T细胞淋巴瘤预后评估的价值

Abstract

目的 探讨正电子发射计算机断层显像/X线计算机体层成像(PET/CT)检测在结外自然杀伤细胞/T细胞淋巴瘤(NK/TCL)临床预后判断中的应用价值.方法 选取首都医科大学附属北京同仁医院病理科2007年1月至2016年7月间确诊、并于初诊时进行PET/CT检查的72例NK/TCL住院病例,回顾性分析PET/CT检测结果.采用Kaplan-Meier方法分析PET/CT发现的阳性指标与总生存期的关系.结果 男54例,女18例,中位年龄44.5岁,中位随访时间29.2个月.发病部位:单侧鼻腔26例(36.1％),双侧鼻腔36例(50.0％),鼻咽、口咽及喉咽10例(13.9％).51例(70.8％)累及周围组织:累及鼻翼29例(40.3％)、鼻窦29例(40.3％)、颌面部软组织18例(25.0％)、眼眶12例(16.7％)、上下颌骨及颅底骨8例(11.1％)、眼睑6例(8.3％)、脑组织3例(4.2％)、眼球2例(2.8％).颈部及腹股沟淋巴结肿大54例(75.0％)、脾大10例(13.9％)、肝大2例(2.8％).Kaplan-Meier单因素生存分析发现临床分期和国际预后指数(IPI)均分别与预后相关(均P＜0.05),颌面部软组织、眼睑、眼眶、颌骨及颅底骨及脑组织受累的患者的总生存时间与未受累者相比,差异均有统计学意义(均P＜0.05),扁桃体及腭部、鼻翼鼻根及鼻前庭、鼻窦受累者与未受累者,总生存差异均无统计学意义(均P＞0.05).Cox回归模型多因素分析显示颌骨及颅底受累为独立不良预后因素(P＜0.05).结论 PET/CT检查能通过显示肿物结构及代谢状况两方面的因素,准确地检测出结外NK/TCL的肿瘤侵犯相邻及远隔组织的范围,对临床分期及预后判断具有重要价值.

Objective To explore the value of Positron-Emission Tomography/Computed Tomography (PET/CT) in the prognosis of extranodal NK/T cell lymphoma.Methods The patients of NK/T cell lymphoma diagnosed from January 2007 to July 2016 in Department of Pathology of Beijing Tongren Hospital were enrolled in this study.Seventy-two in-hospital patients were examined on the invasion of adjecent tissue or organ by PET/CT.The PET/CT results were analyzed retrospectively.Kaplan-Meier method was used to analyze the prognostic value of the positive results by PET/CT on overall survival (OS).Results There were 54 males and 18 females with median age of 44.5 years (13-75 years).According to Ann Arbor staging system,there were 16 cases (22.2％) in stage Ⅰ,29 cases (40.3％) in stage Ⅱ,6 cases (8.3％) in stage Ⅲ and 21 cases (29.2％) in stage Ⅳ.According to the IPI scoring system,there were 34 cases (47.2％) in the low risk group (0-1 point),21 cases (29.2％) in the low-middle risk group (2 points),16 cases (22.2％) in the middle-high risk group (3 points),and 1 case (1.4％) in the high risk group (4-5 points).The median follow-up time was 29.2 months (1-118 months).The disease occured in unilateral nasal cavity in 26 cases (36.1％),bilateral nasal cavities in 36 cases (50.0％),nasopharynx,oropharynx and pharynx in 10 cases (13.9％).The tumors of 51 cases involved the surrounding tissue,including nasal wings in 29 cases (40.3％),nasal sinus in 29 cases (40.3％),maxillofacial soft tissue in 18 cases (25.0％),orbital in 12 cases (16.7％),maxilla and skull base in 8 cases (11.1％),eyelid in 6 cases (8.3％),brain tissue in 3 cases (4.2％),eyeball in 2 cases (2.8％).In addition,cervical and inguinal lymphadenopathy were found in 54 cases (75.0％).Splenomegaly and hepatomegaly were found in 10 cases (13.9％) and 2 cases (2.8％),respectively.Survival analysis showed that the clinical stage and IPI were significantly associated the clinical prognosis (P =0.000,0.001,respectively).Involvement of the maxillofacial soft tissue,eyelid,orbital,maxilla and skull base and brain tissue were significantly related to reduced the overall survival time (P =0.006,0.000,0.024,0.001 and 0.015,respectively).Involvement of palate or tonsil,the nosewingand nasal sinus did not show significant shorter overall survival (P =0.091,0.063,and 0.139,respectively).Cox regression multivariate analysis showed maxilla and skull base involvement was independent adverse prognostic factor (P =0.047).Conclusions The PET/CT examination can accurately detect the extent of adjacent and distant tissues of tumor involvement of NK/T cell lymphoma by showing the tumor structure and metabolic status,thus has important value in the clinical staging and prognosis predication.