Wijewardene Ayanthi, Hoang Jeremy, Maw Aung Min, Gild Matti, Tacon Lyndal, Roach Paul, Schembri Geoffrey, Chan David, Clifton-Bligh Roderick
Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Clin Endocrinol (Oxf). 2023 Mar;98(3):436-446. doi: 10.1111/cen.14804. Epub 2022 Aug 15.
We propose a new scoring system (I-PET) combining whole body scan (WBS) and FDG findings to identify patients who have or are likely to become refractory to radioactive iodine.
Retrospective analysis of 142 patients age >18 with differentiated thyroid cancer who had a F-18 labelled fluoro-2-deoxyglucose ( F-FDG) positron emission tomography (PET) and WBS within a 6-month period between 2010 and 2020. Pairs of F-FDG PET and WBS were reviewed by three independent nuclear medicine physicians and an I-PET score was assigned: I-PET [0]: Iodine -ve/FDG -ve, I-PET [1]: Iodine +ve/FDG -ve, I-PET [2]: Iodine +ve/FDG +ve and I-PET [3]: Iodine -ve/FDG +ve. Patients with FDG +ve lesions (I-PET [2] and I-PET [3]) were further classified into groups A and B if SUVmax was ≤5 or >5, respectively. Follow-up data were obtained by chart review. Progression was defined as structural progression as per RECIST 1.1 or further surgical intervention; or biochemical progression as unstimulated thyroglobulin increasing >20% from baseline.
Of 142 patients included in the study 121 patients had follow-up data available for review. At baseline, 49 patients were classified as I-PET [0], 10 as I-PET [1], 16 as I-PET [2] and 46 as I-PET [3]. Progression was seen in 11/49 (22%) of I-PET [0], 4/10 (40%) of I-PET [1], 10/16 (63%) of I-PET [2] and 34/46 (74%) of I-PET [3] (p < 0.001). I-PET [2B] and I-PET [3B] had a progression rate of 88% (7/8) and 78% (25/32), respectively. I-PET [3B] were 9.6 times more likely to commence multikinase inhibitor therapy (p = 0.001) and had 8 times greater mortality (p = 0.003) than patients in other I-PET groups combined.
I-PET is a simple readily acquired imaging biomarker that potentially enhances the dynamic risk stratification and guide treatment in thyroid cancer.
我们提出一种新的评分系统（I-PET），该系统结合全身扫描（WBS）和氟代脱氧葡萄糖（FDG）检查结果，以识别对放射性碘治疗有抵抗或可能产生抵抗的患者。
对2010年至2020年期间142例年龄大于18岁的分化型甲状腺癌患者进行回顾性分析，这些患者在6个月内接受了F-18标记的氟代-2-脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）和WBS检查。由三名独立的核医学医师对F-FDG PET和WBS检查结果进行评估，并给出I-PET评分：I-PET[0]：碘摄取阴性/FDG摄取阴性；I-PET[1]：碘摄取阳性/FDG摄取阴性；I-PET[2]：碘摄取阳性/FDG摄取阳性；I-PET[3]：碘摄取阴性/FDG摄取阳性。FDG摄取阳性（I-PET[2]和I-PET[3]）的患者，如果最大标准摄取值（SUVmax）≤5或>5，则进一步分为A组和B组。通过查阅病历获取随访数据。进展定义为根据实体瘤疗效评价标准（RECIST）1.1确定的结构进展或进一步的手术干预；或生化进展，即非刺激状态下甲状腺球蛋白较基线水平升高>20%。
纳入研究的142例患者中，121例有可供审查的随访数据。基线时，49例患者被分类为I-PET[0]，10例为I-PET[1]，16例为I-PET[2]，46例为I-PET[3]。I-PET[0]组中有11/49（22%）出现进展，I-PET[1]组中有4/10（40%），I-PET[2]组中有10/16（63%），I-PET[3]组中有34/46（74%）（p<0.001）。I-PET[2B]和I-PET[3B]的进展率分别为88%（7/8）和78%（25/32）。与其他I-PET组的患者相比，I-PET[3B]组开始接受多激酶抑制剂治疗的可能性高9.6倍（p=0.001），死亡率高8倍（p=0.003）。
I-PET是一种简单易获取的成像生物标志物，可能会增强甲状腺癌的动态风险分层并指导治疗。
