Distant metastatic lesions in patients with differentiated thyroid carcinoma

Summary

Aim: Many investigators have reported an inverse relationship between iodine and glucose utilization of differentiated thyroid carcinoma (DTC) according to its degree of differentiation; however, not every DTC is compatible with this phenomenon. This study was conducted to evaluate the clinical implication of iodine and glucose uptake at distant metastatic lesions in DTC patients. Patients, methods: 64 DTC patients (women 47; mean age 49.9 ± 16.4 years) with distant metastasis who underwent post ¹³¹I treatment whole-body scan (RxWBS) and FDG PET/CT were included in the study. Radioiodine (RAI) and FDG uptake of metastatic lesions were evaluated. TSH stimulated serum thyroglobulin (s-Tg) were obtained. Results: 53 of 64 patients (82.8%) were RAI(+) group, and 37 patients (57.8%) were FDG(+) group. Patients in the RAI(–) group showed a higher rate of FDG uptake than RAI(+) group (100.0% vs. 49.1%, p = 0.002). Patients in the FDG(–) group showed a higher rate of RAI uptake than FDG(+) group (100.0% vs. 70.3%, p = 0.002). Patients with s-Tg < 100 ng/ml were frequently observed in the FDG(–)/RAI(+) group and the FDG(+)/ RAI(–) group (p = 0.023). And patients with s-Tg ≥ 500 ng/ml were more frequently observed in the FDG(+)/RAI(+) group, compared with the FDG(+)/RAI(–) group (p = 0.036). Reduced disease-specific survival (DSS) was observed in patients with RAI(–) (p = 0.003), FDG(+) (p = 0.006), SUVmax > 3.6 (p<0.001), and s-Tg > 75.8 ng/ml (p = 0.009). In multivariate analysis, only a SUVmax > 3.6 was significantly predictive of DSS (p = 0.006). Conclusion: An inverse relationship between RAI and FDG uptake, flip-flop phenomenon, was observed in patients with metastatic lesions of DTC. Reduced disease-specific survival was observed in patients with FDG(+), RAI(–) in metastatic lesions, or high s-Tg value.

Zusammenfassung

Ziel: Über den umgekehrten Zusammenhang zwischen Iod- und Glukoseverwertung des differenzierten Schilddrüsenkarzinoms (DTC) entsprechend dem Differenzierungsgrad wurde oft berichtet. Doch dieses Phänomen trifft nicht auf jedes DTC zu. Diese Studie wurde durchgeführt, um bei DTC-Patienten die klinischen Folgen der Iod- und Glukoseaufnahme in Fernmetastasen zu untersuchen. Patienten, Methoden: An der Studie nahmen 64 DTC-Patienten (47 Frauen; mittleres Alter 49,9 ± 16,4 Jahre) mit Fernmetastasen teil, bei denen je eine Ganzkörper-Szintigraphie (RxWBS) und FDG-PET/ CT-Untersuchung nach 131I-Behandlung vorgenommen wurde. Die Radioiod (RAI)- und FDG-Aufnahme der Fernmetastasen wurden untersucht und Thyroglobulin im Serum unter TSH-Stimulation (s-Tg) bestimmt. Ergebnisse: 53 von 64 Patienten (82,8%) wurden der RAI(+)-Gruppe, 37 Patienten (57,8%) der FDG(+)-Gruppe zugeordnet. Patienten der RAI(–)-Gruppe wiesen eine höhere Aufnahmerate von FDG auf als die RAI(+)-Gruppe (100,0% gegenüber 49,1%, p = 0,002). Patienten in der FDG(–)- Gruppe wiesen eine höhere Aufnahmerate von RAI auf als die FDG(+)-Gruppe (100,0% gegenüber 70,3%, p = 0,002). Patienten mit s-Tg < 100 ng/ ml waren häufig in der FDG(–)/RAI(+)-Gruppe und FDG(+)/RAI(–)-Gruppe anzutreffen (p = 0,023). Patienten mit s-Tg ≥ 500 ng/ ml waren häufiger in der FDG(+)/RAI(+)-Gruppe als in der FDG(+)/ RAI(–)-Gruppe anzutreffen (p = 0,036). Bei Patienten mit RAI(–) (p = 0,003), FDG(+) (p = 0,006), SUVmax > 3,6 (p<0,001) und s-Tg > 75,8 ng/ ml (p = 0,009) wurde ein niedrigeres krankheitsspezifisches Überleben (DSS) beobachtet. Bei der multivariaten Analyse war nur eine SUVmax > 3,6 signifikant prädiktiv für das DSS (p = 0,006). Schlussfolgerung: Bei Patienten mit DTC-Metastasen wurde ein umgekehrter Zusammenhang zwischen RAIund FDG-Aufnahme (Flip-Flop-Phänomen) beobachtet. Bei Patienten mit FDG(+) und RAI(–) in Metastasen oder hohem s-Tg-Wert wurde ein niedrigeres krankheitsspezifisches Überleben festgestellt.

Keywords

Flip-flop phenomenon - FDG - iodine - differentiated thyroid cancer - survival

Schlüsselwörter

Flip-Flop-Phänomen - FDG - Iod - differenziertes Schilddrüsenkarzinom - Überleben

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