Kersting David, Seifert Robert, Kessler Lukas, Herrmann Ken, Theurer Sarah, Brandenburg Tim, Dralle Henning, Weber Frank, Umutlu Lale, Führer-Sakel Dagmar, Görges Rainer, Rischpler Christoph, Weber Manuel
Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
Cancers (Basel). 2021 Apr 6;13(7):1728. doi: 10.3390/cancers13071728.
The clinical phenotype of poorly differentiated thyroid cancer (PDTC) can vary substantially. We aim to evaluate risk factors for radioiodine refractory (RAI-R) disease and reduced overall survival (OS).
We retrospectively screened our institutional database for PDTC patients. For the assessment of RAI-R disease, we included patients who underwent dual imaging with F-FDG-PET and I-PET/I scintigraphy that met the internal standard of care. We tested primary size, extrathyroidal extension (ETE), and age >55 years as risk factors for RAI-R disease at initial diagnosis and during the disease course using uni- and multivariate analyses. We tested metabolic tumor volume (MTV), total lesion glycolysis (TLG) on F-FDG-PET, and the progression of stimulated thyroglobulin within 4-6 months of initial radioiodine therapy as prognostic markers for OS.
Size of primary >40 mm and ETE were significant predictors of RAI-R disease in the course of disease in univariate (81% vs. 27%, = 0.001; 89% vs. 33%, < 0.001) and multivariate analyses. Primary tumor size was an excellent predictor of RAI-R disease (AUC = 0.90). TLG/MTV > upper quartile and early thyroglobulin progression were significantly associated with shorter median OS (29.0 months vs. 56.9 months, < 0.05; 57.8 months vs. not reached < 0.005, respectively).
PDTC patients, especially those with additional risk factors, should be assessed for RAI-R disease at initial diagnosis and in the course of disease, allowing for early implementation of multimodal treatment. Primary tumor size >40 mm, ETE, and age >55 are significant risk factors for RAI-R disease. High MTV/TLG is a significant risk factor for premature death and can help identify patients requiring intervention.
低分化甲状腺癌（PDTC）的临床表型差异很大。我们旨在评估放射性碘难治性（RAI-R）疾病的危险因素以及总体生存期（OS）缩短的情况。
我们对机构数据库中的PDTC患者进行了回顾性筛查。为评估RAI-R疾病，我们纳入了接受符合内部护理标准的F-FDG-PET和I-PET/I闪烁扫描双重成像的患者。我们使用单因素和多因素分析，将原发灶大小、甲状腺外侵犯（ETE）以及年龄>55岁作为初始诊断时和疾病过程中RAI-R疾病的危险因素进行检测。我们将F-FDG-PET上的代谢肿瘤体积（MTV）、总病变糖酵解（TLG）以及初始放射性碘治疗后4 - 6个月内刺激甲状腺球蛋白的进展情况作为OS的预后标志物进行检测。
在单因素分析（81%对27%，P = 0.001；89%对33%，P < 0.001）和多因素分析中，原发灶>40 mm和ETE是疾病过程中RAI-R疾病的显著预测因素。原发肿瘤大小是RAI-R疾病的优秀预测指标（AUC = 0.90）。TLG/MTV>上四分位数和早期甲状腺球蛋白进展与较短的中位OS显著相关（分别为29.0个月对56.9个月，P < 0.05；57.8个月对未达到，P < 0.005）。
PDTC患者，尤其是那些有其他危险因素的患者，在初始诊断时和疾病过程中应评估RAI-R疾病，以便早期实施多模式治疗。原发肿瘤大小>40 mm、ETE以及年龄>55岁是RAI-R疾病的显著危险因素。高MTV/TLG是过早死亡的显著危险因素，可帮助识别需要干预的患者。
