Prognostic value of baseline, interim and end-of-treatment 18F-FDG PET/CT parameters in extranodal natural killer/T-cell lymphoma: A meta-analysis

The prognostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in extranodal natural killer/T-cell lymphoma (ENKTL) is currently controversial. Furthermore, whether the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and Deauville 5-point scale (DS) acquired from PET/CT are predictors of prognosis in ENKTL remains unclear. The aim of this study was to explore the relationship between baseline, interim and end-of-treatment PET/CT (B-PET/CT, I-PET/CT and E-PET/CT) parameters and ENKTL prognosis.MethodsWe searched the PubMed, EMBASE, Cochrane Library and Medline databases for eligible articles. SUVmax, MTV, and TLG on B-PET/CT, DS on I-PET/CT and DS on E-PET/CT were regarded as efficacy data. Combined hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were estimated using RevMan 5.3 software.ResultsNine trials with a total of 535 ENKTL patients were included. SUVmax, MTV and TLG on B-PET/CT were significantly associated with PFS with HRs of 2.78 (95%CI 1.54–5.03), 3.61 (95%CI 1.96–6.65) and 5.62 (95%CI 1.94–16.33), respectively, and with OS with HRs of 4.78 (95%CI 2.29–9.96), 3.20 (95%CI 1.55–6.60) and 7.76 (95%CI 1.79–33.58), respectively. For the DS on I-PET/CT, the HRs for PFS and OS were 5.15 (95%CI 2.71–9.80) and 5.80 (95%CI 2.28–14.73), respectively. Similarly, the DS on E-PET/CT was a significant predictor of PFS and OS with HRs of 3.65 (95%CI 2.13–6.26) and 3.32 (95%CI 1.79–6.15), respectively.ConclusionOur results suggest that SUVmax, MTV, TLG on B-PET/CT, DS on I-PET/CT and DS on E-PET/CT may be significant prognostic indicators for PFS and OS in ENKTL patients. Moreover, TLG tends to be superior to SUVmax and MTV on B-PET/CT for predicting survival of ENKTL patients. Therefore, response monitoring and prognostication assessments based on multiple PET/CT parameters should be considered in the management of ENKTL patients.目前，18F-氟代脱氧葡萄糖正电子发射断层显像-计算机断层扫描（18F-fluorodeoxyglucose positron emission tomography-computed tomography，18F-FDG PET/CT）在结外自然杀伤/T细胞淋巴瘤（extranodal natural killer/T-cell lymphoma，ENKTL）中的预后价值尚存争议。此外，通过PET/CT获取的最大标准化摄取值（maximum standardized uptake value，SUVmax）、代谢肿瘤体积（metabolic tumor volume，MTV）、总病灶糖酵解（total lesion glycolysis，TLG）以及多维尔5分评分量表（Deauville 5-point scale，DS）是否可作为ENKTL的预后预测因子，目前仍不明确。本研究旨在探讨基线、中期及治疗结束时PET/CT（B-PET/CT、I-PET/CT及E-PET/CT）相关参数与ENKTL预后之间的关联。 方法 我们在PubMed、EMBASE、Cochrane图书馆及Medline数据库中检索符合纳入标准的文献。将B-PET/CT的SUVmax、MTV及TLG，以及I-PET/CT和E-PET/CT的DS作为疗效数据。采用RevMan 5.3软件估算无进展生存期（progression-free survival，PFS）和总生存期（overall survival，OS）的合并风险比（hazard ratios，HRs）。 结果 共纳入9项临床试验，总计535例ENKTL患者。B-PET/CT的SUVmax、MTV及TLG与PFS显著相关，对应的风险比分别为2.78（95%CI 1.54~5.03）、3.61（95%CI 1.96~6.65）及5.62（95%CI 1.94~16.33）；与OS的关联对应的风险比分别为4.78（95%CI 2.29~9.96）、3.20（95%CI 1.55~6.60）及7.76（95%CI 1.79~33.58）。针对I-PET/CT的DS，其预测PFS和OS的风险比分别为5.15（95%CI 2.71~9.80）与5.80（95%CI 2.28~14.73）。同理，E-PET/CT的DS亦可显著预测PFS与OS，对应的风险比分别为3.65（95%CI 2.13~6.26）及3.32（95%CI 1.79~6.15）。 结论 本研究结果表明，B-PET/CT的SUVmax、MTV、TLG，以及I-PET/CT和E-PET/CT的DS或可作为ENKTL患者PFS与OS的重要预后指标。此外，B-PET/CT的TLG在预测ENKTL患者生存方面，其效能优于SUVmax与MTV。因此，在ENKTL患者的临床管理中，应考虑基于多参数PET/CT进行疗效监测与预后评估。