甲状腺残留组织消融术后的 FDG PET 比放射性碘摄取对分化型甲状腺癌高危患者的长期生存具有更高的预测价值。

FDG PET performed at thyroid remnant ablation has a higher predictive value for long-term survival of high-risk patients with well-differentiated thyroid cancer than radioiodine uptake.

机构信息

From the *Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; †Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich; ‡Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany; and §Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

出版信息

Clin Nucl Med. 2015 May;40(5):378-83. doi: 10.1097/RLU.0000000000000699.

DOI:10.1097/RLU.0000000000000699

PMID:25608175

Abstract

PURPOSE

The predictive value of FDG PET at thyroid remnant ablation was evaluated in comparison to radioiodine uptake in high-risk patients with differentiated thyroid cancer.

PATIENTS AND METHODS

One hundred forty-one patients who underwent radioiodine therapy (RIT) after total thyroidectomy and received at least 1 further RIT due to suspected metastases were retrospectively analyzed. Patients had not received RIT previously. FDG PET was performed before thyroid remnant ablation. Thyroid-stimulating hormone-stimulated serum thyroglobulin (Tg) was measured for biochemical response assessment (change of Tg between the first and second RIT, ΔTg).

RESULTS

Biochemical response could be evaluated in 80 patients; survival data could be obtained for 88 patients (maximum, 124 months). Biochemical response was significantly better in patients with radioiodine-positive metastases compared with patients with radioiodine-negative metastases (median ΔTg I+, 55.8% vs I-, 112.6%; P < 0.01). Regarding survival, deaths occurred later in patients with radioiodine-positive metastases compared with radioiodine-negative patients; however, there was no significant difference regarding overall survival (I+, 61.3% vs I-, 58.2%; P > 0.05). Patients with FDG-positive metastases at thyroid remnant ablation showed a poorer biochemical response compared with patients with FDG-negative metastases (median ΔTg FDG+, 77.5% vs FDG-, 53.2%; P < 0.05), and these groups also differed significantly regarding survival (overall survival FDG+, 48.5% vs FDG-, 100%, P < 0.05).

CONCLUSIONS

At thyroid remnant ablation, FDG PET is more predictive for long-term survival, whereas radioiodine uptake is more important for short-term response. FDG PET performed at thyroid remnant ablation might represent a useful tool for management of high-risk patients with differentiated thyroid cancer.

摘要

目的

评估 18F-FDG PET 在甲状腺残留组织消融术（thyroid remnant ablation）中的预测价值，并与分化型甲状腺癌高危患者的放射性碘摄取（radioiodine uptake）进行比较。

方法

回顾性分析了 141 例在甲状腺全切除术后接受放射性碘治疗（RIT）并因疑似转移而接受至少 1 次进一步 RIT 的患者。患者之前未接受过 RIT。在甲状腺残留组织消融术之前进行 18F-FDG PET 检查。检测甲状腺刺激激素（thyroid-stimulating hormone，TSH）刺激的血清甲状腺球蛋白（thyroglobulin，Tg），以评估生化反应（两次 RIT 之间 Tg 的变化，ΔTg）。

结果

80 例患者的生化反应可进行评估；88 例患者（最长随访时间 124 个月）的生存数据可获得。放射性碘阳性转移患者的生化反应明显优于放射性碘阴性转移患者（中位数ΔTg I+，55.8% vs I-，112.6%；P<0.01）。在生存方面，放射性碘阳性转移患者的死亡时间晚于放射性碘阴性患者，但总生存无显著差异（I+，61.3% vs I-，58.2%；P>0.05）。在甲状腺残留组织消融术时，18F-FDG 阳性转移患者的生化反应较 18F-FDG 阴性转移患者差（中位数ΔTg FDG+，77.5% vs FDG-，53.2%；P<0.05），两组的生存情况也存在显著差异（总生存 FDG+，48.5% vs FDG-，100%；P<0.05）。