Objective: To explore the value of Positron-Emission Tomography/Computed Tomography (PET/CT) in the prognosis of extranodal NK/T cell lymphoma. Methods: The patients of NK/T cell lymphoma diagnosed from January 2007 to July 2016 in Department of Pathology of Beijing Tongren Hospital were enrolled in this study. Seventy-two in-hospital patients were examined on the invasion of adjecent tissue or organ by PET/CT. The PET/CT results were analyzed retrospectively. Kaplan-Meier method was used to analyze the prognostic value of the positive results by PET/CT on overall survival (OS). Results: There were 54 males and 18 females with median age of 44.5 years (13-75 years). According to Ann Arbor staging system, there were 16 cases (22.2%) in stage Ⅰ, 29 cases (40.3%) in stage Ⅱ, 6 cases (8.3%) in stage Ⅲ and 21 cases (29.2%) in stage Ⅳ. According to the IPI scoring system, there were 34 cases (47.2%) in the low risk group (0-1 point), 21 cases (29.2%) in the low-middle risk group (2 points), 16 cases (22.2%) in the middle-high risk group (3 points), and 1 case (1.4%) in the high risk group (4-5 points) . The median follow-up time was 29.2 months (1-118 months). The disease occured in unilateral nasal cavity in 26 cases (36.1%), bilateral nasal cavities in 36 cases (50.0%), nasopharynx, oropharynx and pharynx in 10 cases (13.9%). The tumors of 51 cases involved the surrounding tissue, including nasal wings in 29 cases (40.3%), nasal sinus in 29 cases (40.3%), maxillofacial soft tissue in 18 cases (25.0%), orbital in 12 cases (16.7%), maxilla and skull base in 8 cases (11.1%), eyelid in 6 cases (8.3%), brain tissue in 3 cases (4.2%), eyeball in 2 cases (2.8%). In addition, cervical and inguinal lymphadenopathy were found in 54 cases (75.0%) . Splenomegaly and hepatomegaly were found in 10 cases (13.9%) and 2 cases (2.8%), respectively. Survival analysis showed that the clinical stage and IPI were significantly associated the clinical prognosis (P=0.000, 0.001, respectively). Involvement of the maxillofacial soft tissue, eyelid, orbital, maxilla and skull base and brain tissue were significantly related to reduced the overall survival time (P=0.006, 0.000, 0.024, 0.001 and 0.015, respectively). Involvement of palate or tonsil, the nosewingand nasal sinus did not show significant shorter overall survival (P=0.091, 0.063, and 0.139, respectively). Cox regression multivariate analysis showed maxilla and skull base involvement was independent adverse prognostic factor (P=0.047). Conclusions: The PET/CT examination can accurately detect the extent of adjacent and distant tissues of tumor involvement of NK/T cell lymphoma by showing the tumor structure and metabolic status, thus has important value in the clinical staging and prognosis predication.
目的： 探讨正电子发射计算机断层显像/X线计算机体层成像(PET/CT)检测在结外自然杀伤细胞/T细胞淋巴瘤(NK/TCL)临床预后判断中的应用价值。 方法： 选取首都医科大学附属北京同仁医院病理科2007年1月至2016年7月间确诊、并于初诊时进行PET/CT检查的72例NK/TCL住院病例，回顾性分析PET/CT检测结果。采用Kaplan－Meier方法分析PET/CT发现的阳性指标与总生存期的关系。 结果： 男54例，女18例，中位年龄44.5岁，中位随访时间29.2个月。发病部位：单侧鼻腔26例(36.1%)，双侧鼻腔36例(50.0%)，鼻咽、口咽及喉咽10例(13.9%)。51例(70.8%)累及周围组织：累及鼻翼29例(40.3%)、鼻窦29例(40.3%)、颌面部软组织18例(25.0%)、眼眶12例(16.7%)、上下颌骨及颅底骨8例(11.1%)、眼睑6例(8.3%)、脑组织3例(4.2%)、眼球2例(2.8%)。颈部及腹股沟淋巴结肿大54例(75.0%)、脾大10例(13.9%)、肝大2例(2.8%)。Kaplan－Meier单因素生存分析发现临床分期和国际预后指数(IPI)均分别与预后相关(均P<0.05)，颌面部软组织、眼睑、眼眶、颌骨及颅底骨及脑组织受累的患者的总生存时间与未受累者相比，差异均有统计学意义(均P<0.05)，扁桃体及腭部、鼻翼鼻根及鼻前庭、鼻窦受累者与未受累者，总生存差异均无统计学意义(均P>0.05)。Cox回归模型多因素分析显示颌骨及颅底受累为独立不良预后因素(P<0.05)。 结论： PET/CT检查能通过显示肿物结构及代谢状况两方面的因素，准确地检测出结外NK/TCL的肿瘤侵犯相邻及远隔组织的范围，对临床分期及预后判断具有重要价值。.
Keywords: Lymphoma, T-cell; Positron-Emission Tomography/Computed Tomography; Prognosis.