摘要
目的评估骨髓活检对基于疗前PET-CT分期结外NK/T细胞淋巴瘤鼻型(ENKTCL)的诊断及预后价值。方法回顾分析2013—2021年福建医科大学附属协和医院初诊ENKTCL的186例完成骨髓活检及骨髓穿刺的患者资料,分为骨髓穿刺+骨髓活检组(186例)、PET-CT分期+骨髓活检组(139例),比较组间灵敏度、特异度、阳性预测值与阴性预测值,对数据进行分析绘图并采用Kaplan-Meier法和log-rank检验进行生存分析。结果全组患者中骨髓活检阳性45例(24.2%),其中骨髓穿刺阳性30例。141例骨髓活检阴性的患者中骨髓穿刺也均为阴性。139例患者同时完成疗前PET-CT分期与骨髓活检,30例PET-CT诊断骨髓阳性患者中22例经骨髓活检确诊,109例PET-CT骨髓阴性患者中虽有5例骨髓活检阳性,但均因同时有其他远处部位转移而被诊为Ⅳ期。PET-CT对于骨髓受侵的诊断灵敏度为81.5%,特异度为92.9%,阳性预测值为73.3%,阴性预测值为95.4%。其中PET-CT诊断的早期(Ⅰ-Ⅱ期)患者,骨髓活检均为阴性(阴性预测值为100%)。在Ⅳ期患者(55例)中,骨髓活检或PET-CT提示骨髓阳性的患者(35例)与其他器官受累的Ⅳ期患者(20例)对比,1年总生存率分别为28.7%和42.0%(P=0.13),1年无进展生存率分别为23.2%和23.3%(P=0.94)。结论基于PET-CT分期的早期ENKTCL常规骨髓活检不改变原有分期;晚期患者中骨髓阳性患者生存率有更差的趋势,骨髓活检仍有一定价值。
Objective To analyze the diagnostic and prognostic value of routine bone marrow examination in patients with extranodal NK/T-cell lymphoma(ENKTCL)based on PET-CT staging.Methods Clinical data of 186 patients who received bone marrow biopsy and bone marrow aspiration in Fujian Medical University Union Hospital from 2013 to 2021 were retrospectively analyzed.All patients were divided into bone marrow biopsy+bone marrow aspiration group(n=186)and PET-CT+bone marrow biopsy group(n=139).The sensitivity,specificity,positive and negative predictive values were compared between two groups.The data were analyzed and plotted.Survival analysis was performed using Kaplan-Meier method and log-rank test.Results In the whole cohort,45 patients were positive for bone marrow biopsy,and 30 of them were positive for bone marrow aspiration.A total of 141 patients who were negative for bone marrow biopsy also achieved negative results for bone marrow aspiration.A total of 139 patients completed PET-CT staging and bone marrow biopsy.And 30 patients were diagnosed with positive bone marrow by PET-CT,in which 22 of them were confirmed positive by bone marrow biopsy.Among 109 patients diagnosed with negative bone marrow by PET-CT,5 of them were confirmed positive by bone marrow biopsy.All these cases were classified as stageⅣdue to distant metastases.PET-CT had a diagnostic sensitivity of 81.5%,a specificity of 92.9%,a positive predictive value of 73.3%,and a negative predictive value of 95.4%.Among early stage(Ⅰ-Ⅱstage)patients diagnosed with PET-CT,all of them were negative for bone marrow biopsy(the negative predictive value was 100%).In stageⅣpatients(n=55),the 1-year overall survival of patients with bone marrow involvement by bone marrow biopsy or PET-CT(n=35)compared with their counterparts with the involvement of other organs(n=20)was 28.7%vs.42.0%(P=0.13),and 1-year progression free survival rates was 23.2%vs.23.3%in(P=0.94).Conclusions Routine bone marrow biopsy does not change the original staging of patients with early stage ENKTCL based on PET-CT staging.Advanced stage patients with positive bone marrow biopsy tend to obtain worse prognosis,indicating that bone marrow biopsy still has certain value.
作者
郑昊
杨勇
邱燕燕
廖斯琴
黄成
施桂清
赵瑞芝
唐天兰
王顺源
陈司霖
刘庭波
徐本华
Zheng Hao;Yang Yong;Qiu Yanyan;Liao Siqin;Huang Cheng;Shi Guiqing;Zhao Ruizhi;Tang Tianlan;Wang Shunyuan;Chen Silin;Liu Tingbo;Xu Benhua(Department of Radiation Oncology,Fujian Medical University Union Hospital,Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors(Fujian Medical University),Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies),Fuzhou 350001,China;Department of Hematology,Fujian Medical University Union Hospital,Fuzhou 350001,China;Center of PET-CT,Fujian Medical University Union Hospital,Fuzhou 350001,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2023年第4期313-318,共6页
Chinese Journal of Radiation Oncology
基金
福建省健康科技基金(2021CXA011)
福建省自然科学基金(2022J02037)。
