在几个国家，早期两个周期化疗后使用PET作功能成像的个体化治疗（PET-2）已成为晚期霍奇金淋巴瘤（AS-HL）的标准护理。然而，到目前为止，PET-2中残留的代谢性疾病的分布以及多个受累区域的预后相关性尚未报告。我们回顾性分析了包括HD18中所有PET-2阳性患者的数据。根据Deauville分数（DS），将残留组织与参考区域进行了目测比较。PET-2阳性被定义为残留组织摄取量高于肝脏（DS4）。使用Kaplan-Meier和Cox回归分析了PFS，定义为从分期至进展、复发或因任何原因死亡的时间，或者分析病情状态的最后一天信息。对比了PET-2中有1-2个和>2个阳性区域的患者以及随机分组到HD18比较组的无PET-2阳性区域的患者。 在2008年至2014年期间，招募了1964例新诊断的AS-HL患者参加HD18，并在PET-2扫描后进行了随机分组。其中，480例患者的PET-2为阳性，并符合本分析的条件。近一半的患者上纵隔有残留组织：230例（47.9%），下纵隔有残留组织：195例（40.6%）。372例（77.5%）患者在PET-2中有1-2个阳性区域。1-2个区域的患者5年无进展生存率为91.7%（CI95：88.7-94.6），而>2个区域的患者为81.8%（CI95：74.2-90.1），相应的风险比（HR）为2.2（CI95：1.2-4.0）。与未接受PET-2阳性疾病并接受6-8个周期化疗的患者相比，1-2个阳性区域的患者患PFS事件的风险较高（HR 1.35；CI95 0.81-2.28），但在统计学上不具有显著性（p=0.25）。而有>2个PET-2阳性病灶的患者风险显著增高（HR 2.95；CI95：1.62-5.37；p<0.001）。 AS-HL的PET-2阳性残余主要位于纵隔，大多数患者只有少数受累区域。具有两个以上PET-2阳性区域的患者进展的风险增加了两倍。© 2023年作者。

Response-adapted treatment using early interim functional imaging with PET after two cycles of chemotherapy (PET-2) for advanced-stage Hodgkin's lymphoma (AS-HL) is the standard of care in several countries. However, the distribution of residual metabolic disease in PET-2 and the prognostic relevance of multiple involved regions have not been reported to date.We retrospectively analyzed data from all PET-2-positive patients included in HD18. Residual tissue was visually compared with reference regions according to the Deauville score (DS). PET-2 positivity was defined as residual tissue with uptake above the liver (DS4). PFS was defined as the time from staging until progression, relapse, or death from any cause, or to the day when information was last received on the patient's disease status and analyzed using Kaplan-Meier and Cox regressions. Comparisons were made between patients with 1-2 and >2 positive regions in PET-2 as well as patients without PET-2-positive regions randomized into comparator arms of HD18.Between 2008 and 2014, 1964 patients with newly diagnosed AS-HL were recruited in HD18 and randomized following their PET-2 scan. Of these, 480 patients had a positive PET-2 and were eligible for this analysis. Upper and lower mediastinum in almost half of all patients: 230 (47.9%) and 195 (40.6%), respectively. 372 (77.5%) of patients have 1-2 positive regions in PET-2. 5y-PFS for patients with 1-2 regions was 91.7% (CI95: 88.7-94.6) vs. 81.8% (CI95: 74.2-90.1) for those with >2 regions with a corresponding hazard ratio (HR) of 2.2 (CI95: 1.2-4.0). Compared with patients without PET-2-positive disease receiving 6-8 cycles of chemotherapy, patients with 1-2 had a higher risk for a PFS event (HR 1.35; CI95 0.81-2.28), but it was not statistically significant (p=0.25). Patients with >2 PET-2-positive lesions had a significantly higher risk (HR 2.95; CI95: 1.62-5.37; p<0.001).PET-2-positive residuals of AS-HL are mostly located in the mediastinum, and a majority of patients have few affected regions. The risk of progression was twofold higher in patients with more than two positive regions in PET-2.© 2023. The Author(s).