Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography scanning.
OBJECTIVE
Approximately 15% of thyroid cancer patients develop subsequent metastases. The clinical course of patients with metastatic thyroid carcinoma is highly variable. We hypothesized that the metabolic activity of metastatic lesions, as defined by retention of 2-[(18)F]fluoro-2-deoxyglucose (FDG), would correlate with prognosis.


METHODS
The initial FDG-positron emission tomography (PET) scans from 400 thyroid cancer patients were retrospectively reviewed and compared with overall survival (median follow-up, 7.9 yr). We examined the prognostic value of clinical information such as gender, age, serum thyroglobulin, American Joint Committee on Cancer (AJCC) stage, histology, radioiodine avidity, FDG-PET positivity, number of FDG-avid lesions, and the glycolytic rate of the most active lesion.


RESULTS
Age, initial stage, histology, thyroglobulin, radioiodine uptake, and PET outcomes all correlated with survival by univariate analysis. However, only age and PET results continued to be strong predictors of survival under multivariate analysis. The initial American Joint Committee on Cancer stage was not a significant predictor of survival by multivariate analysis. There were significant inverse relationships between survival and both the glycolytic rate of the most active lesion and the number of FDG-avid lesions.


CONCLUSIONS
FDG-PET scanning is a simple, expensive, but powerful means to restage thyroid cancer patients who develop subsequent metastases, assigning them to groups that are either at low (FDG negative) or high (FDG positive) risk of cancer-associated mortality. We propose that the aggressiveness of therapy for metastases should match the FDG-PET status.
Robbins
Richard J
RJ
Department of Medicine, Memorial Hospital for Cancer and Allied Diseases, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. rjrobbins@tmh.tmc.edu
Wan
Qiang
Q
Grewal
Ravinder K
RK
Reibke
Roland
R
Gonen
Mithat
M
Strauss
H William
HW
Tuttle
R Michael
RM
Drucker
William
W
Larson
Steven M
SM
D000328:Adult; D000367:Age Factors; D018265:Carcinoma, Papillary, Follicular / Q000097:blood / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012737:Sex Factors; D016019:Survival Analysis; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D013972:Thyrotropin / Q000097:blood
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D013972:Thyrotropin; D013954:Thyroglobulin