vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2023-20-1-7-16vestim-887Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEПрогностическое значение полноты метаболического ответа у пациентов с диффузной В-крупноклеточной лимфомойPrognostic value of the completeness of the metabolic response in patients with diffused large B-cell lymphomaКаленикО. А.KalenikV. A.

Каленик Ольга Александровна – канд. мед. наук, вед. науч. сотрудник

223040, а/г Лесной, Минский р-н

Volha A. Kalenik – Ph. D. (Med.), Leading Researcher

223040, Lesnoy, Minsk region

olga.a.kalenik@mail.ruhttps://orcid.org/0000-0003-0592-7182КонопляН. Е.KonoplyaN. E.

Конопля Наталья Евгеньевна – д-р мед. наук, профессор, гл. науч. сотрудник

223040, а/г Лесной, Минский р-н

 

Natalya E. Konoplya – D. Sc. (Med.), Professor, Chief Researcher

223040, Lesnoy, Minsk region

nkonoplya@mail.ruhttps://orcid.org/0000-0002-1324-3656ДемешкоП. Д.DziameshkaP. D.

Демешко Павел Дмитриевич ‒ д-р мед. наук, доцент, гл. науч. сотрудник

223040, а/г Лесной, Минский р-н

Pavel D. Dziameshka ‒ D. Sc. (Med.), Associate Professor, Chief Researcher

223040, Lesnoy, Minsk region

pdemeshko@icloud.comКрасныйС. А.KrasnyS. A.

Красный Сергей Анатольевич ‒ академик, д-р мед. наук, профессор, заместитель директора

223040, а/г Лесной, Минский р-н

Sergei A. Krasny ‒ Academician, D. Sc. (Med.), Professor, Deputy Director

223040, Lesnoy, Minsk region

sergeykrasny@tut.byРеспубликанский научно-практический центр онкологии и медицинской радиологии им. Н. Н. АлександроваN. N. Alexandrov National Cancer Centre202301032023201716Copyright © Каленик О.А., Конопля Н.Е., Демешко П.Д., Красный С.А., 20232023Каленик О.А., Конопля Н.Е., Демешко П.Д., Красный С.А.Kalenik V.A., Konoplya N.E., Dziameshka P.D., Krasny S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/887

Применяемые в настоящее время прогностические факторы долгосрочных результатов стандартного лечения диффузной В-крупноклеточной лимфомы (ДВКЛ) недостаточно точны для прогнозирования исходов. Прогностическое значение промежуточной позитронно-эмиссионной томографии с 18F-фтордезоксиглюкозой, совмещенной с КТ (ФДГ-ПЭТ/КТ), при ДВКЛ остается спорным.

Цель исследования – оценить прогностическую значимость полноты метаболического ответа у пациентов с ДВКЛ после 4 курсов химиоиммунотерапии относительно отдаленных результатов лечения.

В период с 2015 по 2020 г. в РНПЦ ОМР им. Н. Н. Александрова исходное и промежуточное ФДГ-ПЭТ/КТ после 4 циклов химиотерапии по схеме R-CHOP прошли 180 пациентов с ДВКЛ. Результаты, полученные с помощью метода Каплана–Мейера, показали, что ФДГ-ПЭТ/КТ ретроспективно коррелировали с выживаемостью без прогрессирования (ВБП). Ответ оценивали по критериям Довиля: ПЭТ-отрицательный – Довиль 1–2, ПЭТ-положительный – Довиль 3–5. Для стратификации на группы риска использовали международный прогностический индекс (IPI).

После 4 курсов химиотерапии ПЭТ-положительные очаги были обнаружены у 76 пациентов, отрицательные – у 104. Анализ выживаемости показал статистически значимую связь между полнотой метаболического ответа и ВБП (р <  0,001). Семилетняя ВБП у ПЭТ-отрицательных пациентов составила 91,1 %, у ПЭТ-положительных – 41,2 %. Пятилетняя ВБП с баллами IPI 0–1, 2–3 и 4–5 для ПЭТ-негативных пациентов составила 97,5; 93,4 и 66,7 %, для ПЭТ-положительных – 55,6; 50,6 и 23,1 % соответственно.

Метаболический ответ по данным промежуточной ФДГ-ПЭТ/КТ является предиктором ВБП при ДВККЛ. Ранняя оценка ответа на химиотерапию с помощью ФДГ-ПЭТ/КТ позволит определять подгруппы пациентов, которым требуется интенсификация лечения. 

The currently used prognostic factors for long-term results of standard treatment of diffuse large B-cell lymphoma (DLBCL) are not clear enough to predict outcomes. The prognostic significance of interim PET/CT in DLBCL remains controversial. The aim of this study is to determine the predictive value of interim 18F-FDG PET/CT after first-line treatment in patients with DLBCL.  

One hundred-eighty patients with DLBCL underwent baseline and interim 18F-FDG PET/CT scans after 4 cycles of R-CHOP during the period of 2015–2020 at the N. N. Alexandrov National Cancer Centre of Belarus. Interim 18F-FDG PET/ CT findings were retrospectively correlated to the progression-free survival (PFS) using the Kaplan–Meier analysis. The metabolic response was assessed according Deauville criteria: PET-negative – Deauville 1–2, PET-positive – Deauville 3–5. The International prognostic index (IPI) was used for risk stratification. 

After 4 cycles of chemotherapy, PET-positive lesions were found in 76 patients and negative scans – in 104 patients. Survival analyses showed highly significant relationships between early interim 18F-FDG PET/CT imaging and PFS (p < 0.001). For PET-negative patients, the 7-year PFS rate was 91.1 %, for PET-positive patients it is 41.2 %. 5-year PFS rates for PET-negative patients with IPI scores 0–1, 2–3 and 4–5 were 97.5, 93.4 and 66.7 %, respectively. For PET-positive patients, 5-year PFS rates in the same subgroups were 55.6, 50.6 and 23.1 %, respectively.  

Early interim 18F-FDG PET/CT imaging is a predictor of PFS in DLBCL. An early assessment of chemotherapy response with 18F-FDG PET/CT scans may provide useful information on selection of patients for escalated therapeutic strategies. 

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The authors declare that there are no conflicts of interest present.