Matsuo Mioko, Baba Shingo, Hashimoto Kazuki, Isoda Takuro, Kitamura Yoshiyuki, Kogo Ryunosuke, Jiromaru Rina, Hongo Takahiro, Manako Tomomi, Nakagawa Takashi
Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan;
Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Anticancer Res. 2023 Jan;43(1):183-190. doi: 10.21873/anticanres.16148.
BACKGROUND/AIM: Differentiated thyroid cancer (DTC) has a good prognosis, except in the case of patients with radioiodine therapy (RIT)-refractory cancer. However, since DTC is essentially a slowly progressing cancer, it is usually judged to be a DTC with a poor prognosis after multiple RITs and yearly follow-up with echo, computed tomography (CT), and serum thyroglobulin values. This study investigated whether fluorodeoxyglucose-positron emission tomography/CT (FDG PET/CT) combined with initial RIT could identify early-stage patients with poor prognosis.
We evaluated 100 patients with high-risk DTC who underwent total thyroidectomy and received RIT at our institution. We analyzed the clinical outcomes of patients and F-FDG accumulation using univariate and multivariate Cox proportional hazards regression models.
The 10-year overall survival (OS) was 87.9%, with no significant difference in OS between F-FDG accumulation at pre-total or near-total thyroidectomy (NTT) (p=0.180) and I accumulation at initial RIT (p=0.577). However, F-FDG positive patients had a significantly worse prognosis than negative patients (p=0.005) at initial RIT.
F-FDG PET/CT plays an important role in both the diagnosis and prognostic prediction of RIT refractory disease in DTC patients. F-FDG PET/CT can be a useful tool particularly at the time of initial RIT since the F-FDG accumulation enables the screening of high-risk DTC with poor prognosis at a very early time stage.
背景/目的：分化型甲状腺癌（DTC）预后良好，但放射性碘治疗（RIT）难治性癌症患者除外。然而，由于DTC本质上是一种进展缓慢的癌症，在多次RIT以及每年通过超声、计算机断层扫描（CT）和血清甲状腺球蛋白值进行随访后，通常被判定为预后不良的DTC。本研究调查了氟脱氧葡萄糖正电子发射断层扫描/CT（FDG PET/CT）联合初始RIT是否能识别预后不良的早期患者。
我们评估了100例在我院接受全甲状腺切除术并接受RIT的高危DTC患者。我们使用单因素和多因素Cox比例风险回归模型分析了患者的临床结局和F-FDG摄取情况。
10年总生存率（OS）为87.9%，全甲状腺切除术前或近全甲状腺切除术（NTT）时F-FDG摄取（p=0.180）与初始RIT时碘摄取（p=0.577）之间的OS无显著差异。然而，在初始RIT时，F-FDG阳性患者的预后明显比阴性患者差（p=0.005）。
FDG PET/CT在DTC患者RIT难治性疾病的诊断和预后预测中均发挥重要作用。FDG PET/CT可能是一种有用的工具，特别是在初始RIT时，因为F-FDG摄取能够在非常早期阶段筛查预后不良的高危DTC。
