Soyluoglu Selin, Tastekin Ebru, Andac Burak, Korkmaz Ulku, Orun Seyma Gizem, Durmus Altun Gulay
Nuclear Medicine, Trakya University, Faculty of Medicine, Edirne, TUR.
Pathology, Trakya University, Faculty of Medicine, Edirne, TUR.
Cureus. 2023 Sep 5;15(9):e44751. doi: 10.7759/cureus.44751. eCollection 2023 Sep.
The role of the tumor microenvironment in tumor progression and treatment response is being investigated for different types of cancer. This study aimed to determine the relationships between tumor microenvironment, histopathology, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)-based metabolic parameters, treatment response, and overall survival (OS) in metastatic differentiated thyroid cancer (DTC). Methods: Metastatic DTC patients who underwent 18F-FDG PET/CT between 2015-2019 were evaluated. Clinicopathological, histopathological features and PET/CT parameters of patients were recorded. Microenvironmental characteristics of the primary tumor, such as mitosis, intratumoral and peritumoral lymphocytosis, intratumoral and peritumoral fibrosis, were evaluated from the tissue samples. The relationships between these factors were statistically analyzed.
Sixty-five patients (38 females, 27 males, age: 49±15 years) were included. Mitosis, intra/peritumoral lymphocytosis, and intra/peritumoral fibrosis were frequent; however, none of them had a statistically significant association with PET-positive metastases, treatment response, or OS. Univariate analysis showed that gender, size, thyroglobulin values, residual thyroid tissue, PET-positive metastases, and maximum standardized uptake value (SUVmax) were significant predictors of OS. At multivariate analysis, PET-positive metastases (HR=-2.65, 95%CI 0.007-0.707, p=0.024) and SUVmax (HR=-2.74, 95%CI 0.006-0.687, p=0.023) were the only independent predictors for OS. Conclusion: Our study revealed that microenvironmental characteristics of the primary tumor did not show prognostic significance in metastatic DTC. PET-positive metastases and SUVmax levels were the only significant factors that predicted overall survival in DTC. Supporting the results of our study with further studies with a larger sample size may be necessary to determine the relationship between the tumor microenvironment and prognosis in DTC.
针对不同类型癌症，肿瘤微环境在肿瘤进展和治疗反应中的作用正在被研究。本研究旨在确定转移性分化型甲状腺癌（DTC）中肿瘤微环境、组织病理学、基于18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）的代谢参数、治疗反应和总生存期（OS）之间的关系。方法：对2015年至2019年间接受18F-FDG PET/CT检查的转移性DTC患者进行评估。记录患者的临床病理、组织病理学特征和PET/CT参数。从组织样本中评估原发性肿瘤的微环境特征，如有丝分裂、肿瘤内和肿瘤周围淋巴细胞浸润、肿瘤内和肿瘤周围纤维化。对这些因素之间的关系进行统计学分析。
纳入65例患者（38例女性，27例男性，年龄：49±15岁）。有丝分裂、肿瘤内/周围淋巴细胞浸润和肿瘤内/周围纤维化较为常见；然而，它们均与PET阳性转移灶、治疗反应或总生存期无统计学显著关联。单因素分析显示，性别、肿瘤大小、甲状腺球蛋白值、残余甲状腺组织、PET阳性转移灶和最大标准化摄取值（SUVmax）是总生存期的显著预测因素。多因素分析时，PET阳性转移灶（HR=-2.65，95%CI 0.007-0.707，p=0.024）和SUVmax（HR=-2.74，95%CI 0.006-0.687，p=0.023）是总生存期的唯一独立预测因素。结论：我们的研究表明，原发性肿瘤的微环境特征在转移性DTC中未显示出预后意义。PET阳性转移灶和SUVmax水平是预测DTC总生存期的唯一重要因素。可能需要通过更大样本量的进一步研究来支持我们的研究结果，以确定肿瘤微环境与DTC预后之间的关系。
