Yang Ji H, Camacho Cléber P, Lindsey Susan C, Valente Flavia O F, Andreoni Danielle M, Yamaga Lilian Y, Wagner Jairo, Biscolla Rosa Paula M, Maciel Rui M B
Endocr Pract. 2017 Aug;23(8):942-948. doi: 10.4158/EP171806.OR. Epub 2017 Jun 14.
Calcitonin and carcinoembryonic antigen (CEA) doubling times are established prognostic markers in medullary thyroid cancer (MTC). On the other hand, F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) shows an increased rate of detection with high blood tumor marker levels in several cancers. This study aimed to analyze the ability of F-FDG PET/CT to determine prognosis in the follow-up of patients with MTC.
Medical records of 17 patients with MTC who underwent F-FDG PET/CT were analyzed retrospectively. All patients were classified into two groups: stable disease or progressive disease.
Eight patients presented with progressive disease, and all of them showed F-FDG uptake (100%), compared to only 3 of 9 patients who presented in stable condition (33%). F-FDG PET/CT results were able to distinguish progressive from stable disease (P = .009). Calcitonin levels >4,020 pg/mL (P = .0004), CEA levels >26.8 ng/mL (P = .04), and a calcitonin doubling time <24.1 months (P = .015) were associated with progressive disease in our cohort. The proportion of variance explained that predicted progressive disease was 32% for F-FDG uptake, 27.1% for a calcitonin doubling time of 24.1 months, and 41.2% for doubling time plus F-FDG PET/CT.
F-FDG uptake was able to distinguish progressive from stable disease. However, this tool should not replace the validated calcitonin doubling time, but rather the combination of information could improve the clinical re-assessment and better identify high-risk patients who require more careful surveillance.
CEA = carcinoembryonic antigen CT = computed tomography F-FDG = F-fluorodeoxyglucose MTC = medullary thyroid cancer PET = positron emission tomography PVE = proportion of variance explained sCT = serum calcitonin SUV = standard uptake value US = ultrasound.
降钙素和癌胚抗原（CEA）倍增时间是甲状腺髓样癌（MTC）已确立的预后标志物。另一方面，氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）显示，在几种癌症中，血液肿瘤标志物水平高时检测率会提高。本研究旨在分析FDG PET/CT在MTC患者随访中判断预后的能力。
回顾性分析17例接受FDG PET/CT检查的MTC患者的病历。所有患者分为两组：疾病稳定或疾病进展。
8例患者疾病进展，所有患者均显示FDG摄取（100%），而9例病情稳定的患者中只有3例显示FDG摄取（33%）。FDG PET/CT结果能够区分疾病进展和稳定（P = 0.009）。在我们的队列中，降钙素水平>4,020 pg/mL（P = 0.0004）、CEA水平>26.8 ng/mL（P = 0.04）以及降钙素倍增时间<24.1个月（P = 0.015）与疾病进展相关。解释疾病进展预测的方差比例，FDG摄取为32%，降钙素倍增时间24.1个月为27.1%，降钙素倍增时间加FDG PET/CT为41.2%。
FDG摄取能够区分疾病进展和稳定。然而，该工具不应取代已得到验证的降钙素倍增时间，而是信息的组合可以改善临床重新评估，并更好地识别需要更密切监测的高危患者。
CEA = 癌胚抗原；CT = 计算机断层扫描；FDG = 氟脱氧葡萄糖；MTC = 甲状腺髓样癌；PET = 正电子发射断层扫描；PVE = 解释的方差比例；sCT = 血清降钙素；SUV = 标准摄取值；US = 超声
