Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2022; 21: 145-154
Прогностическая значимость метаболических параметров инициальной позитронноэмиссионной томографии, совмещенной с компьютерной томографией, с 18F-фтордезоксиглюкозой в оценке выживаемости у детей с лимфомой (метаанализ и обзор литературы)
Ликарь Ю. Н., Ядгаров М. Я., Мякова Н. В.
https://doi.org/10.24287/1726-1708-2022-21-1-145-154Аннотация
Пятилетняя общая выживаемость (ОВ) при детских неходжкинских лимфомах (НХЛ) и лимфоме Ходжкина (ЛХ) остается на уровне 85–95%, несмотря на совершенствование схем терапии. На сегодняшний день задача выявления достоверных прогностических факторов, позволяющих идентифицировать пациентов из группы высокого/ультравысокого риска, не решена. Мы провели систематический обзор литературы и метаанализ исследований прогностической ценности инициальных метаболических параметров накопления фтордезоксиглюкозы, меченной 18F (18F-ФДГ), при выполнении позитронно-эмиссионной томографии, совмещенной с компьютерной томографией (ПЭТ/КТ), у педиатрических пациентов с лимфомами. Поиск проводился в базах данных PubMed, Medline, Cochrane Library и Google Scholar. В исследование были включены 6 ретроспективных исследований (n = 309), оценивающих влияние инициальных параметров количественной оценки ПЭТ/КТ с 18F-ФДГ (максимальное стандартизованное значение поглощения (SUVmax), метаболический объем опухоли (MTV), общий гликолиз опухоли (TLG)) на ОВ и бессобытийную выживаемость (БСВ) у детей с ЛХ и НХЛ. Мы использовали Кокрановский инструмент ROBINS-I для оценки качества исследований, относительные риски (ОР) для изучаемых исходов были рассчитаны в программном продукте RevMan, версия 5.3. Общий анализ данных показал, что высокий показатель MTV был сопряжен с шестикратным увеличением риска летального исхода (ОР = 6,18 (3,15–12,11), p < 0,001) и увеличением риска рецидива/прогрессирования более чем в 5 раз (ОР = 5,68 (3,21–10,07), p < 0,001). Высокие значения TLG были сопряжены с восьмикратным увеличением риска летального исхода (ОР = 8,06 (3,35–19,39), p < 0,001) и меньшей БСВ (ОР = 5,75 (2,99–11,06), p < 0,001). Полученные результаты позволят врачам-онкологам расширить существующие системы оценки рисков за счет включения параметров MTV и TLG для повышения их прогностической эффективности.
Список литературы
1. Buhtoiarov I.N. Pediatric Lymphoma. Pediatr Rev 2017; 38 (9): 410–23.
2. Ward E., DeSantis C., Robbins A., Kohler B., Jemal A. Childhood and adolescent cancer statistics. СА Cancer J Clin 2014; 64 (2): 83–103.
3. Cairo M., Auperin A., Perkins S.L., Pinkerton R., Harrison L., Goldman S., et al. Overall survival of children and adolescents with mature B cell non-Hodgkin lymphoma who had refractory or relapsed disease during or after treatment with FAB/LMB 96: a report from the FAB/LMB 96 study group. Br J Haematol 2018; 182 (6): 859–69.
4. Castellino S.M., Geiger A.M., Mertens A.C., Leisenring W.M., Tooze J.A., Goodman P., et al. Morbidity and mortality in long-term survivors of Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study. Blood 2011; 117 (6): 1806–16.
5. London K., Cross S., Onikul E., Dalla-Pozza L., Howman-Giles R. 18FFDG PET/CT in paediatric lymphoma: comparison with conventional imaging. Eur J Nucl Med Mol Imaging 2011; 38(2): 274–84.
6. Barrington S.F., Mikhaeel N.G., Kostakoglu L., Meignan M., Hutchings M., Müeller S.P., et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 2014; 32 (27): 3048–58.
7. Cheson B.D., Fisher R.I., Barrington S.F., Cavalli F., Schwartz L.H., Zucca E., et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32 (27): 3059–68.
8. Ferrari C., Niccoli Asabella A., Merenda N., Altini C., Fanelli M., Muggeo P., et al. Pediatric Hodgkin Lymphoma: Predictive value of interim 18F-FDG PET/CT in therapy response assessment. Medicine (Baltimore) 2017; 96 (5): e5973.
9. Kostakoglu L., Chauvie S. Metabolic tumor volume metrics in lymphoma. Semin Nucl Med 2018; 48 (1): 50–66.
10. Park Y.S., Lee S.M., Park J.S., Bae S.K., Shim H.K., Lee W.S., et al. Evaluating the Predictive Ability of Initial Staging F-18 FDG PET/ CT for the Prognosis of Non-Hodgkin Malignant Lymphoma Patients Who Underwent Stem Cell Transplantation. Nucl Med Mol Imaging 2018; 52 (3): 216–23.
11. Wang H., Shen G., Jiang C., Li L., Cui F., Tian R. Prognostic value of baseline, interim and end-of-treatment 18F-FDG PET/CT parameters in extranodal natural killer/T-cell lymphoma: A meta-analysis. PLoS One 2018; 13 (3): e0194435.
12. Guo B., Tan X., Ke Q., Cen H. Prognostic value of baseline metabolic tumor volume and total lesion glycolysis in patients with lymphoma: A meta-analysis. PLoS One 2019; 14 (1): e0210224.
13. Moher D., Liberati A., Tetzlaff J., Altman D.G. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (7): e1000097.
14. Higgins J.P., Thomas J., Chandler J., Cumpston M., Li T., Page M.J., et al. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons; 2019.
15. Begg C.B., Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50 (4): 1088–101.
16. Egger M., Davey Smith G., Schneider M., Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315 (7109): 629–34.
17. Mathew B., Vijayasekharan K., Shah S., Purandare N.C., Agrawal A., Puranik A., et al. Prognostic Value of 18F-FDG PET/CT-Metabolic Parameters at Baseline and Interim Assessment in Pediatric Anaplastic Large Cell Lymphoma. Clin Nucl Med 2020; 45 (3): 182–6.
18. Yang J., Yan J., Li J., Zhang H., Xu W. Prognostic value of metabolic parameters in baseline 18F-FDG PET/CT for pediatric lymphoblastic lymphoma. Authorea Preprints 2020.
19. Chen S., He K., Feng F., Wang S., Yin Y., Fu H., et al. Metabolic tumor burden on baseline 18F-FDG PET/CT improves risk stratification in pediatric patients with mature B-cell lymphoma. Eur J Nucl Med Mol Imaging 2019; 46 (9): 1830–9.
20. Zhou Y., Hong Z., Zhou M., Sang S., Zhang B., Li J., et al. Prognostic value of baseline 18F‐FDG PET/CT metabolic parameters in paediatric lymphoma. J Med Imaging Radiat Oncol 2020; 64 (1): 87–95.
21. Milgrom S.A., Kim J., Chirindel A., Kim J., Pei Q., Chen L., et al. Prognostic value of baseline metabolic tumor volume in children and adolescents with intermediate-risk Hodgkin lymphoma treated with chemo-radiation therapy: FDG-PET parameter analysis in a subgroup from COG AHOD0031. Pediatr Blood Cancer 2021; 68 (9): e29212.
22. Xiao Z., Mo Y., Long W., Li R., Li X., Wei Y., et al. Value of baseline and end of chemotherapy 18F-FDG PET/ CT in pediatric patients with Burkitt lymphoma. Leuk Lymphoma 2021; 62 (12): 2873–81.
23. Albano D., Bertoli M., Battistotti M., Rodella C., Statuto M., Giubbini R., et al. Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma. Ann Nucl Med 2018; 32 (8): 532–41.
24. Meignan M., Sasanelli M., Casasnovas R.O., Luminari S., Fioroni F., Coriani C., et al. Metabolic tumour volumes measured at staging in lymphoma: methodological evaluation on phantom experiments and patients. Eur J Nucl Med Mol Imaging 2014; 41 (6): 1113–22.
Pediatric Hematology/Oncology and Immunopathology. 2022; 21: 145-154
Predictive value of metabolic parameters of baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography for survival rates of children with lymphoma (a metaanalysis and literature review)
Likar Yu. N., Yadgarov M. Ya., Myakova N. V.
https://doi.org/10.24287/1726-1708-2022-21-1-145-154Abstract
The five-year overall survival (OS) rate for pediatric Hodgkin's (HL) and non-Hodgkin's (NHL) lymphomas remains at 85–95% despite improvements in therapy regimens. The problem of establishing reliable prognostic factors that could help identify high- or ultra-high-risk patients is still unresolved. We performed a systematic literature review and meta-analysis of studies investigating the predictive value of baseline metabolic parameters of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in pediatric patients with lymphomas. We systematically searched the following databases: PubMed, Medline, Cochrane Library and Google Scholar. Six retrospective studies (309 patients) evaluating the effect of quantitative parameters derived from baseline PET/CT with 18F-FDG (maximum standardized uptake value (SUVmax), tumor metabolic volume (MTV), and total lesion glycolysis (TLG)) on OS and event-free survival (EFS) in children with HL and NHL were included in our analysis. We used the Cochrane ROBINS-I tool to assess the quality of studies; the relative risks (RR) for the studied outcomes were calculated with RevMan software, version 5.3. The overall analysis showed that high MTV was associated with a six-fold increase in the relative mortality risk (RR 6.18 (3.15–12.11), p < 0.001) and a more than 5-fold increase in the risk of relapse/progression (RR 5.68 (3.21–10.07), p < 0.001). High values of TLG were associated with an eight-fold increase in the risk of mortality (RR 8.06 (3.35–19.39), p < 0.001) and worse EFS (RR 5.75 (2.99–11.06), p < 0.001). Our results will enable oncologists to expand existing risk assessment systems and improve their predictive effectiveness by using MTV and TLG parameters.
References
1. Buhtoiarov I.N. Pediatric Lymphoma. Pediatr Rev 2017; 38 (9): 410–23.
2. Ward E., DeSantis C., Robbins A., Kohler B., Jemal A. Childhood and adolescent cancer statistics. SA Cancer J Clin 2014; 64 (2): 83–103.
3. Cairo M., Auperin A., Perkins S.L., Pinkerton R., Harrison L., Goldman S., et al. Overall survival of children and adolescents with mature B cell non-Hodgkin lymphoma who had refractory or relapsed disease during or after treatment with FAB/LMB 96: a report from the FAB/LMB 96 study group. Br J Haematol 2018; 182 (6): 859–69.
4. Castellino S.M., Geiger A.M., Mertens A.C., Leisenring W.M., Tooze J.A., Goodman P., et al. Morbidity and mortality in long-term survivors of Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study. Blood 2011; 117 (6): 1806–16.
5. London K., Cross S., Onikul E., Dalla-Pozza L., Howman-Giles R. 18FFDG PET/CT in paediatric lymphoma: comparison with conventional imaging. Eur J Nucl Med Mol Imaging 2011; 38(2): 274–84.
6. Barrington S.F., Mikhaeel N.G., Kostakoglu L., Meignan M., Hutchings M., Müeller S.P., et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 2014; 32 (27): 3048–58.
7. Cheson B.D., Fisher R.I., Barrington S.F., Cavalli F., Schwartz L.H., Zucca E., et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32 (27): 3059–68.
8. Ferrari C., Niccoli Asabella A., Merenda N., Altini C., Fanelli M., Muggeo P., et al. Pediatric Hodgkin Lymphoma: Predictive value of interim 18F-FDG PET/CT in therapy response assessment. Medicine (Baltimore) 2017; 96 (5): e5973.
9. Kostakoglu L., Chauvie S. Metabolic tumor volume metrics in lymphoma. Semin Nucl Med 2018; 48 (1): 50–66.
10. Park Y.S., Lee S.M., Park J.S., Bae S.K., Shim H.K., Lee W.S., et al. Evaluating the Predictive Ability of Initial Staging F-18 FDG PET/ CT for the Prognosis of Non-Hodgkin Malignant Lymphoma Patients Who Underwent Stem Cell Transplantation. Nucl Med Mol Imaging 2018; 52 (3): 216–23.
11. Wang H., Shen G., Jiang C., Li L., Cui F., Tian R. Prognostic value of baseline, interim and end-of-treatment 18F-FDG PET/CT parameters in extranodal natural killer/T-cell lymphoma: A meta-analysis. PLoS One 2018; 13 (3): e0194435.
12. Guo B., Tan X., Ke Q., Cen H. Prognostic value of baseline metabolic tumor volume and total lesion glycolysis in patients with lymphoma: A meta-analysis. PLoS One 2019; 14 (1): e0210224.
13. Moher D., Liberati A., Tetzlaff J., Altman D.G. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (7): e1000097.
14. Higgins J.P., Thomas J., Chandler J., Cumpston M., Li T., Page M.J., et al. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons; 2019.
15. Begg C.B., Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50 (4): 1088–101.
16. Egger M., Davey Smith G., Schneider M., Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315 (7109): 629–34.
17. Mathew B., Vijayasekharan K., Shah S., Purandare N.C., Agrawal A., Puranik A., et al. Prognostic Value of 18F-FDG PET/CT-Metabolic Parameters at Baseline and Interim Assessment in Pediatric Anaplastic Large Cell Lymphoma. Clin Nucl Med 2020; 45 (3): 182–6.
18. Yang J., Yan J., Li J., Zhang H., Xu W. Prognostic value of metabolic parameters in baseline 18F-FDG PET/CT for pediatric lymphoblastic lymphoma. Authorea Preprints 2020.
19. Chen S., He K., Feng F., Wang S., Yin Y., Fu H., et al. Metabolic tumor burden on baseline 18F-FDG PET/CT improves risk stratification in pediatric patients with mature B-cell lymphoma. Eur J Nucl Med Mol Imaging 2019; 46 (9): 1830–9.
20. Zhou Y., Hong Z., Zhou M., Sang S., Zhang B., Li J., et al. Prognostic value of baseline 18F‐FDG PET/CT metabolic parameters in paediatric lymphoma. J Med Imaging Radiat Oncol 2020; 64 (1): 87–95.
21. Milgrom S.A., Kim J., Chirindel A., Kim J., Pei Q., Chen L., et al. Prognostic value of baseline metabolic tumor volume in children and adolescents with intermediate-risk Hodgkin lymphoma treated with chemo-radiation therapy: FDG-PET parameter analysis in a subgroup from COG AHOD0031. Pediatr Blood Cancer 2021; 68 (9): e29212.
22. Xiao Z., Mo Y., Long W., Li R., Li X., Wei Y., et al. Value of baseline and end of chemotherapy 18F-FDG PET/ CT in pediatric patients with Burkitt lymphoma. Leuk Lymphoma 2021; 62 (12): 2873–81.
23. Albano D., Bertoli M., Battistotti M., Rodella C., Statuto M., Giubbini R., et al. Prognostic role of pretreatment 18F-FDG PET/CT in primary brain lymphoma. Ann Nucl Med 2018; 32 (8): 532–41.
24. Meignan M., Sasanelli M., Casasnovas R.O., Luminari S., Fioroni F., Coriani C., et al. Metabolic tumour volumes measured at staging in lymphoma: methodological evaluation on phantom experiments and patients. Eur J Nucl Med Mol Imaging 2014; 41 (6): 1113–22.
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