Abstract
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.
Highlights
Extranodal natural killer/T-cell lymphoma (ENKTL) is a highly aggressive type of lymphoma with a median survival time of less than 12 months and with a remarkable geographical prevalence in Asia and South America [1,2]
SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on BPET/CT were significantly associated with progression-free survival (PFS) with hazard ratios (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 overall survival (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
Our results suggest that SUVmax, MTV, TLG on B-positron emission tomography-computed tomography (PET/CT), Deauville 5-point scale (DS) on I-PET/CT and DS on E-PET/CT may be significant prognostic indicators for PFS and OS in ENKTL patients
Summary
Extranodal natural killer/T-cell lymphoma (ENKTL) is a highly aggressive type of lymphoma with a median survival time of less than 12 months and with a remarkable geographical prevalence in Asia and South America [1,2]. No standard effective treatment currently exists, as ENKTL is refractory to chemotherapy and is associated with a high rate of therapeutic failure and poor prognosis [3,4]. Developing optimal approaches for the early identification of patients at high risk of progression or relapse is important in clinical management. The most common approaches include histopathological subtyping and use of the International Prognostic Index (IPI) [5] and the Korean Prognostic Index (KPI) [6]. The immunophenotype and gene expression pattern can be prognostic factors. Previous prognostic indicators based on the presented parameters have several drawbacks, including lack of consideration of the lymphoma response to treatment and insufficiency for accurately identifying patients with immunochemotherapy-refractory disease [7,8]
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