Phuong Nguyen Thi, Son Mai Hong, Thong Mai Huy, Ha Le Ngoc
Department of Nuclear Medicine, Hospital 108, Hanoi, Vietnam.
BMC Med Imaging. 2024 Dec 20;24(1):344. doi: 10.1186/s12880-024-01525-9.
Identifying prognostic markers for clinical outcomes is crucial in selecting appropriate treatment options for patients with radioiodine-refractory (RAI-R) differentiated thyroid carcinoma (DTC). The aim of this study was to investigate the prognostic value of clinico-pathological features and semiquantitative [F]FDG PET/CT metabolic parameters in predicting progression-free survival (PFS) in DTC patients with RAI-R.
This prospective cohort study included 110 consecutive RAI-R DTC patients who were referred for [F]FDG PET/CT imaging. The lesion standard uptake values (SUV)s, including SUVmax, SUVmean, SULpeak as well astotal metabolic tumor volume (tMTV)and total lesion glycolysis (tTLG) were measured. Disease progression was assessed using the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and/or Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0. PFS curves were plotted using Kaplan-Meier analysis. Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors for PFS.
[F]FDG PET/CT metabolic parameters demonstrate predictive value for PFS in RAI-R DTC patients, with sensitivity ranging from 70.7% to 81% and specificity from 75% to 92.3% (p < 0.001). PFS was significantly worse in patients with SUVmax > 6.39 g/ml, SUVmean > 3.68 g/ml, SULpeak > 3.14 g/ml, tTLG > 4.23 g/ml × cm, and tMTV > 1.24 cm. Clinico-pathological factors including age > 55, aggressive variant and follicular histological subtype, extra-thyroidal extension of the primary tumor, stage III - IV disease at initial DTC diagnosis, distant metastases detected on [F]FDG PET/CT, and metabolic parameters of [F]FDG PET/CT associated with PFS in univariate analysis (p < 0.01). In multivariate analysis, extra-thyroidal extension (HR: 2.25; 95% CI: 1.22 - 4.16; p = 0.01), distant metastases on [F]FDG PET/CT (HR: 2.98; 95%CI: 1.62 - 5.5; p < 0.001), and tMTV > 1.24 cm (HR: 4.17; 95% CI: 2.02 - 8.6; p < 0.001), were independent prognostic factors for PFS.
In addition to classic clinico-pathological factors, the semiquantitative [F]FDG PET/CT metabolic parameters can be utilized for dynamic risk stratification for progression in RAI-R DTC patients. Furthermore, extra-thyroidal extension of the primary tumor, distant metastases, and tMTV > 1.24 cm are independent prognostic factors for PFS.
识别临床结局的预后标志物对于为放射性碘难治性（RAI-R）分化型甲状腺癌（DTC）患者选择合适的治疗方案至关重要。本研究的目的是探讨临床病理特征和半定量[F]FDG PET/CT代谢参数在预测RAI-R DTC患者无进展生存期（PFS）方面的预后价值。
这项前瞻性队列研究纳入了110例连续的因[F]FDG PET/CT成像而转诊的RAI-R DTC患者。测量了病变的标准摄取值（SUV），包括SUVmax、SUVmean、SULpeak以及总代谢肿瘤体积（tMTV）和总病变糖酵解（tTLG）。使用实体瘤疗效评价标准（RECIST）1.1和/或实体瘤正电子发射断层显像疗效标准（PERCIST）1.0评估疾病进展。采用Kaplan-Meier分析绘制PFS曲线。进行单因素和多因素Cox回归分析以确定PFS的预后因素。
[F]FDG PET/CT代谢参数对RAI-R DTC患者的PFS具有预测价值，敏感性范围为70.7%至81%，特异性范围为75%至92.3%（p < 0.001）。SUVmax > 6.39 g/ml、SUVmean > 3.68 g/ml、SULpeak > 3.14 g/ml、tTLG > 4.23 g/ml×cm和tMTV > 1.24 cm的患者PFS明显更差。临床病理因素包括年龄>55岁、侵袭性变异型和滤泡组织学亚型、原发肿瘤的甲状腺外扩展、初次DTC诊断时的III - IV期疾病、[F]FDG PET/CT上检测到的远处转移以及[F]FDG PET/CT的代谢参数在单因素分析中与PFS相关（p < 0.01）。在多因素分析中，甲状腺外扩展（HR：2.25；95%CI：1.22 - 4.16；p = 0.01）、[F]FDG PET/CT上的远处转移（HR：2.98；95%CI：1.62 - 5.5；p < 0.001）和tMTV > 1.24 cm（HR：4.17；95%CI：2.02 - 8.6；p < 0.001）是PFS的独立预后因素。
除了经典的临床病理因素外，半定量[F]FDG PET/CT代谢参数可用于RAI-R DTC患者进展的动态风险分层。此外，原发肿瘤的甲状腺外扩展、远处转移和tMTV > 1.24 cm是PFS的独立预后因素。
