18F-FDG PET/CT在接受131碘经验性治疗的分化型甲状腺癌患者中的预后作用

Prognostic role of FDG PET/CT in patients with differentiated thyroid cancer treated with 131-iodine empiric therapy.

作者信息

Salvatore Barbara, Klain Michele, Nicolai Emanuele, D'Amico Domenico, De Matteis Gianluca, Raddi Marco, Fonti Rosa, Pellegrino Teresa, Storto Giovanni, Cuocolo Alberto, Pace Leonardo

机构信息

Istituto di Biostrutture e Bioimmagini, CNR Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli FedericoII IRCCS - SDN, Napoli Medicina Nucleare, IRCCS - CROB, Rionero in Vulture Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana," Università degli Studi di Salerno, Salerno, Italy.

出版信息

Medicine (Baltimore). 2017 Oct;96(42):e8344. doi: 10.1097/MD.0000000000008344.

BACKGROUND

To assess the long-term prognostic value of F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with differentiated thyroid carcinoma (DTC) undergoing empiric radioiodine (RAI) therapy due to raising values of thyroglobulin (Tg).

METHODS

Forty-nine patients with histological diagnosis of DTC (31 with papillary and 18 with follicular carcinoma) follow-up for a mean period of 7.9 ± 5 years after empiric RAI therapy were retrospectively analyzed.

RESULTS

FDG-PET/CT was negative in 15 (30.6%) patients and positive in 34 (69.4%), whereas postradioiodine therapy whole body scan (t-WBS) was negative in 16 (32.7%) and positive in 33 (67.3%) patients. FDG-PET/CT and t-WBS were in agreement in 32 patients (7 both negative and 25 both positive); on the contrary, in 17 patients there was disagreement between FDG-PET/CT and t-WBS (P =ns). At short-term follow-up, Tg normalized in 19 (38.8%) patients and was unchanged or increased in 30 (61.2%). Of the 15 patients with negative FDG-PET/CT, 11 (73.3%) showed Tg normalization, whereas of the 34 patients with positive FDG-PET/CT, only 8 (23.5%) had Tg normalization (χ =8.9, P < .005). At multivariate analysis, FDG-PET/CT and Tg normalization at short-term follow-up were independent predictors of disease-free survival (χ =26.3, P < .0001), while Tg normalization was the only variable associated with overall survival χ =7.2, P < .01).

CONCLUSION

FDG-PET/CT in association with Tg normalization at short-term follow-up may be useful for long-term prognostic stratification in DTC patients.

背景

评估¹⁸F-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）对因甲状腺球蛋白（Tg）值升高而接受经验性放射性碘（RAI）治疗的分化型甲状腺癌（DTC）患者的长期预后价值。

方法

回顾性分析49例经组织学诊断为DTC的患者（31例乳头状癌和18例滤泡状癌），这些患者在经验性RAI治疗后平均随访7.9±5年。

结果

15例（30.6%）患者的FDG-PET/CT为阴性，34例（69.4%）为阳性；而放射性碘治疗后全身扫描（t-WBS）16例（32.7%）为阴性，33例（67.3%）为阳性。32例患者（7例均为阴性，25例均为阳性）的FDG-PET/CT和t-WBS结果一致；相反，17例患者的FDG-PET/CT和t-WBS结果不一致（P=无统计学意义）。在短期随访中，19例（38.8%）患者的Tg恢复正常，30例（61.2%）患者的Tg无变化或升高。15例FDG-PET/CT阴性的患者中，11例（73.3%）的Tg恢复正常，而34例FDG-PET/CT阳性的患者中，只有8例（23.5%）的Tg恢复正常（χ²=8.9，P<0.005）。多因素分析显示，短期随访时FDG-PET/CT和Tg恢复正常是无病生存的独立预测因素（χ²=26.3，P<0.0001），而Tg恢复正常是与总生存相关的唯一变量（χ²=7.2，P<0.01）。