摘要
目的正电子发射型计算机断层显像/计算机体层成像(positron emission tomography/computerized tomography,PET/CT)作为一项新兴的核医学技术,将功能代谢及解剖结构显像有机的结合起来,并且在多发性骨髓瘤(multiple myeloma,MM)中的应用也越来越广泛。本研究探讨初治MM患者的^(18)F-脱氧葡萄糖(18-fluorodeoxyglucose,^(18)F-FDG)PET/CT影像学特征及预后判断价值分析。方法收集2005-12-01-2015-12-01天津市肿瘤医院并于初治前行PET/CT检查的68例MM患者的基本资料,其中包括病变数目及最大标准化摄取值(maximum standardized uptake value,SUV_(max))在内的PET/CT影像特征。采用SPSS 21.0统计软件进行统计学处理,采用Kaplan-Meier法进行生存分析,单因素分析采用Log-rank法,多因素分析采用Cox比例风险模型进行分析。结果 68例初治MM患者,男∶女=1.125∶1,中位年龄58(22~78)岁。其中骨破坏数量>3处58例(85.3%),骨破坏区SUV_(max)>5.0者26例(38.2%),髓外部位SUV_(max)>4.1者12例(17.6%)。随访至2016-08,中位随访时间25.3个月。单因素分析显示,血清β2微球蛋白(β2 microglobulin,β2 MG)≥5.5mg/L(P=0.022)、血清乳酸脱氢酶(lactic dehydrogenase,LDH)>正常值上限(P=0.023)、PET/CT显示髓外病变(P=0.005)、骨破坏数量>3处(P=0.036)及治疗结束未达完全缓解(complete remission,CR)(P=0.014)可能为总生存期(overall survival,OS)的不良预后指标。多因素分析显示,初诊时血清β2 MG≥5.5mg/L(HR=10.076,95%CI为3.8~27.0,P<0.001)、LDH>正常值上限(HR=2.327,95%CI为1.0~5.4,P=0.049)、PET/CT存在髓外病变(HR=0.384,95%CI为0.2~0.7,P=0.002)及治疗结束未达CR(HR=3.652,95%CI为1.4~11.6,P=0.028)为初治MM患者不良预后因素。依据上述4个指标,将本研究中68例初治MM患者分为高危组、中危组和低危组,且组间OS差异有统计学意义,P=0.005。结论 PET/CT能结合临床指标在一定程度预测初治MM患者预后生存,具有一定临床价值。
OBJECTIVE The positron emission tomography/computerized tomography （PET/CT） was used more and more popular in multiple myeloma （MM） as a new technology for combining functional metabolism and anatomic structure together. The aims of this study was to analyze the feature of 18 fluorodeoxyglucose （18 FFDG） PET/CT to as- sess the prognostic value of PET/CT in newly diagnosed MM patients. METHODS Sixty eight newly diagnosed MM pa- tients from 2005-12-01 to 2015-12-01 received treatment in Tianjin Medical University Cancer Institute and Hospital were enrolled in the retrospective study and PET/CT was performed in all of them before treatments. The aim was to summa- rize the feature of MM patients and PET/CT including number of lesions and maximum standardized uptake value （SUV）. We used the statistics software SPSS 21.0 to analysis the results and the Kaplan-Meier to analysis their survival. The univariate analysis was by the method of Log-rank, while multivariate analysis was by the method of the model of Cox. RESULTS There were sixty eight newly diagnosed MM patients in the study, and the proportion of male and fe- male was 1. 125 ： 1. The median age was 58（22--78） years old. There were 58（85.3%） patients whose numbers of bone lesion were more than 3. The number of patients whose bone lesions SUVmax〉5. 0 was 26（38.2%） and the number of ex- tramedullary lesions SUVmax〉4.1 was 12（17.6%）. The time of median follow up was 25.3 months and the deadline was 2016-08. The univariate analysis indicated β2 mieroglobulin （β2 MG） ≥ 5. 5 mg/L （P = 0. 022）, lactic dehydrogenase （LDH）〉the upper limits of normal （P=0. 023）, the extramedullary lesions on PET/CT （P=0. 005）, with numbers of bone lesion more than 3（P=0. 036） and without complete remission （CR） （P=0. 014） at the ending of treatments were associated with shorter overall survival （OS）. In multivariate analysis, β2 MG≥5.5 mg/L（HR： 10. 076,95 %CI：3.8- 27.0,P〈0. 001）, LDH〉the upper
出处
《中华肿瘤防治杂志》
CAS
北大核心
2017年第2期124-129,共6页
Chinese Journal of Cancer Prevention and Treatment
基金
天津市高等学校科技发展基金计划(20140112)
天津市科技计划(13ZCZCSY20300)
