Hodgkin lenfoma hastalarında maksimum tümör çapı ve 18F-FDG PET/BT görüntüleme durumunun genel sağkalıma etkisi

Yıl 2023, , 485 - 491, 27.10.2023

Vildan Gürsoy , Mehmet Refik Göktuğ , Fazıl Çağrı Hunutlu , İbrahim Ethem Pınar , Rıdvan Ali , Vildan Özkocaman , Fahir Özkalemkaş

https://doi.org/10.47582/jompac.1350661

Öz

Amaç: Bu araştırma, tanı anındaki maksimum tümör çapının ve FDG PET BT durumunun sağkalım sonuçlarına etkisini belirlemeyi ve tedaviye yanıtı ve sağkalımı etkileyen prognostik faktörleri değerlendirmeyi amaçlamaktadır.
Yöntemler: Çalışmaya Hodgkin lenfoma tanısı alan 239 hasta katıldı. Sağkalımı etkileyen klinik özellikler, tedavi yanıtları ve prognostik faktörler, arşivlenmiş hasta tıbbi kayıtlarından retrospektif olarak analiz edildi.
Bulgular: Çalışmaya 136 (%56,1) erkek hasta ve 103 (%43,1) kadın hasta katıldı. Bu hastalardan 202'si (%84,5) hayatta kalırken, 37'si (%15,5) çalışma döneminde öldü. Hayatta kalan hastalar ile ölen hastalar karşılaştırıldığında, ölen hastaların ortalama yaşının daha yüksek (p = 0,003), dalak tutulumu ve B semptomlarının prevalansının daha yüksek olduğu (sırasıyla p = 0,011 ve p = 0,001), albümin düzeylerinin daha düşük olduğu (p = 0,008), daha yüksek beta-2 mikroglobulin düzeyleri (p = 0,001) ve daha fazla kemik iliği tutulumu (p = 0,006) görüldü. Beta-2 mikroglobulin düzeyi >2920 olan hastalarda mortalitede dört kat, dalak tutulumu olan hastalarda ise mortalitede 3.188 kat artış görüldü.
Sonuç: Sonuç olarak beta-2 mikroglobulin > 2920, dalak tutulumunun varlığı, nüks varlığı, ve FDG PET BT'de ilerleyici veya dirençli hastalığın varlığı, Hodgkin lenfoma hastalarında 1., 3. ve 5. yıllık sağkalım oranları açısından önemli prognostik faktörlerdi. Ek olarak hayatta kalma oranı ile FDG-PET veya CT ile ölçülen maksimum tümör çapı arasında bir korelasyon yoktu.

Anahtar Kelimeler

Hodgkin lenfoma, prognostik faktörler, klinik göstergeler, FDG PET CT

The effect of maximum tumor diameter and 18F-FDG PET/CT imaging status on overall survival in Hodgkin lymphoma patients

Öz

Aims: This research aims to determine the impact of maximum tumor diameter and FDG PET CT status at the time of diagnosis on survival outcomes and to identify prognostic factors that influence treatment response and survival.
Methods: 239 patients with a diagnosis of Hodgkin lymphoma participated in the study. Clinical characteristics, treatment responses, and prognostic factors influencing survival were retrospectively analyzed from patient medical records.
Results: There were 136 (56.9%) male patients and 103 (43.1%) female patients, who participated in the study. Of these patients, 202 (84.5%) survived, while 37 (15.5%) died during the study period. When surviving patients and non-survivor patients were compared, the deceased patients had a higher mean age (p = 0.003), a higher prevalence of spleen involvement and B symptoms (p = 0.011 and p = 0.001, respectively), lower albumin levels (p = 0.008), higher beta-2 microglobulin levels (p = 0.001), and more bone marrow involvement (p = 0.006). A fourfold increase in mortality was seen in patients with beta-2 microglobulin levels > 2920 mg/L, and a 3.188-fold increase in mortality was seen in patients with spleen involvement.
Conclusion: In conclusion, beta-2 microglobulin > 2920 mg/L, the presence of spleen involvement, the presence of relapse, and the presence of progressive or refractory disease in FDG PET CT were significant prognostic factors for 1st, 3rd, and 5th-year survival rates in patients with Hodgkin lymphoma. In addition, there was no correlation between survival rate and maximum tumor diameter as measured by FDG-PET or CT.

Anahtar Kelimeler

Hodgkin lymphoma, prognostic factors, clinical indicators, FDG PET CT

Kaynakça

• Belsky JA, Hochberg J, Giulino-Roth L. Diagnosis and management of Hodgkin lymphoma in children, adolescents, and young adults. Best Pract Res Clin Haematol. 2023;36(1):101445.
• Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi:10.3322/caac.21708
• Hanel W, Herrera AF, Epperla N. Management of classical Hodgkin lymphoma: a look at up to date evidence and current treatment approaches. Exp Hematol Oncol. 2022;11(1):108.
• Follows AM, Santarsieri A. Minimising the toxicities of first line Hodgkin lymphoma treatment in the modern era. Cancers (Basel). 2022;14(21):5390.
• Barrington SF, Phillips EH, Counsell N, et al. Positron emission tomography score has greater prognostic significance than pretreatment risk stratification in early-stage Hodgkin Lymphoma in the UK RAPID study. J Clin Oncol. 2019;37(20):1732-1741.
• Borchmann P, Plütschow A, Kobe C, et al. PET-guided omission of radiotherapy in early-stage unfavourable Hodgkin lymphoma (GHSG HD17): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2021;22(2):223-234.
• Borchmann P, Goergen H, Kobe C, et al. PET-guided treatment in patients with advanced-stage Hodgkin’s lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group. Lancet. 2017;390(10114):2790-2802.
• Kharazmi E, Fallah M, Pukkala E, et al. Risk of familial classical Hodgkin lymphoma by relationship, histology, age, and sex: a joint study from five Nordic countries. Blood. 2015;126(17):1990-1995.
• Daw S, Hasenclever D, Mascarin M, et al. Risk and response adapted treatment guidelines for managing first relapsed and refractory classical Hodgkin lymphoma in children and young people. recommendations from the EuroNet Pediatric Hodgkin Lymphoma Group. Hemasphere. 2020;4(1):e329.
• Illidge TM, Phillips EH, Counsell N, et al. Maximum tumor diameter is associated with event-free survival in PET-negative patients with stage I/IIA Hodgkin lymphoma. Blood Adv. 2020;4(1):203-206.
• Moskowitz AJ, Schöder H, Gavane S, et al. Prognostic significance of baseline metabolic tumor volume in relapsed and refractory Hodgkin lymphoma. Blood. 2017;130(20):2196-2203.
• Dores GM, Curtis RE, Dalal NH, Linet MS, Morton LM. Cause-specific mortality following initial chemotherapy in a population-based cohort of patients with classical Hodgkin lymphoma, 2000-2016. J Clin Oncol. 2020;38(35):4149-4162.
• Follows GA, Barrington SF, Bhuller KS, et al. Guideline for the first-line management of Classical Hodgkin Lymphoma-A British Society for Haematology guideline. Br J Haematol. 2022;197(5):558-572.
• Goodlad JR, Cerroni L, Swerdlow SH. Recent advances in cutaneous lymphoma-implications for current and future classifications. Virchows Arch. 2023;482(1):281-298.
• de Jong PA, van Ufford HM, Baarslag HJ, et al. CT and 18F-FDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma. AJR Am J Roentgenol. 2009;192(3):745-53.
• Rueffer U, Sieber M, Josting A, et al. Prognostic factors for subdiaphragmatic involvement in clinical stage I-II supradiaphragmatic Hodgkin’s disease: a retrospective analysis of the GHSG. Ann Oncol. 1999;10(11):1343-8.
• Noordijk EM, Carde P, Dupouy N, et al. Combined-modality therapy for clinical stage I or II Hodgkin’s lymphoma: long-term results of the European Organisation for Research and Treatment of Cancer H7 randomized controlled trials. J Clin Oncol. 2006;24(19):3128-35.
• Engert A, Plütschow A, Eich HT, et al. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med. 2010;363(7):640-52.
• Eatrides J, Thompson Z, Lee JH, Bello C, Dalia S. Serum albumin as a stable predictor of prognosis during initial treatment in patients with diffuse large B cell lymphoma. Ann Hematol. 2015;94(2):357-358.
• Gradel KO, Larsen TS, Frederiksen H, et al. Impact of C-reactive protein and albumin levels on short, medium, and long term mortality in patients with diffuse large B-cell lymphoma. Ann Med. 2022;54(1):713-722.
• Al-Ibraheem A, Mottaghy FM, Juweid ME. PET/CT in Hodgkin lymphoma: an update. Semin Nucl Med. 2023;53(3):303-319.
• Juweid ME, Mueller M, Alhouri A, MZ AR, Mottaghy FM. Positron emission tomography/computed tomography in the management of Hodgkin and B-cell non-Hodgkin lymphoma: an update. Cancer. 2021;127(20):3727-3741.
• Cashen AF, Dehdashti F, Luo J, Homb A, Siegel BA, Bartlett NL. 18F-FDG PET/CT for early response assessment in diffuse large B-cell lymphoma: poor predictive value of international harmonization project interpretation. J Nucl Med. 2011;52(3):386-392.