Clinico-pathological factors and [(18)F]FDG PET/CT metabolic parameters for prediction of progression-free survival in radioiodine refractory differentiated thyroid carcinoma.

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 [18F]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 [18F]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. [18F]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 × cm3, and tMTV > 1.24 cm3. 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 [18F]FDG PET/CT, and metabolic parameters of [18F]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 [18F]FDG PET/CT (HR: 2.98; 95%CI: 1.62 - 5.5; p < 0.001), and tMTV > 1.24 cm3 (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 [18F]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 cm3 are independent prognostic factors for PFS.

Phuong NT ，Son MH ，Thong MH ，Ha LN ... -  《BMC MEDICAL IMAGING》

The impact of qualitative [18F]FDG PET/CT in predicting clinical outcomes of post-surgical differentiated thyroid cancer patients with elevated thyroglobulin and negative radioiodine whole-body scan.

[18F]FDG PET/CT has been widely used as a diagnostic tool in detection and localization of recurrent non-avid radioiodine lesions in post-operative differentiated thyroid cancer (DTC) patients with elevated serum thyroglobulin but negative radioiodine whole-body scan (TENIS) syndrome. The aim of our study was to evaluate the role of [18F]FDG PET/CT in prediction on outcomes of these DTC patients. Post-operative DTC patients with TENIS syndrome were collected in the department of nuclear medicine, Hospital 108 from 2019 to 2023. Patients underwent [18F]FDG PET/CT with standard protocol following EANM guideline for tumor imaging version 2.0. The qualitative [18F]FDG PET/CT imaging characteristics were classified into three categories: (i) negative [18F]FDG PET/CT, (ii) minimal [18F]FDG PET/CT volume of lesions, (iii) extensive [18F]FDG PET/CT volume of lesions. Progression-free survival (PFS) and overall survival (OS) were the end point of the study. The prognosis of qualitative [18F]FDG PET/CT in predicting PFS and OS was illustrated by Kaplan-Meier survival analysis. The independent factors predicting PFS and OS were determined by univariate and multivariate analysis using logistic regression. There were 164 consecutive patients, 51.2% female and 48.8% female. The most common histopathological type was papillary accounting for 91.5%. The median time of follow-up was 33.3 months, (range 6.57 - 82.5). There was 70 (36.6%) progressions and 12 (7.35%) deaths. Negative [18F]FDG PET/CT uptake patients had median PFS with median 57.1 months which was higher than that of minimal category (46.2 months), and extensive category (37.6 months) (p < 0,001). 1-year OS and 5-year OS in extensive PET/CT category was 97.8% and 86.2% respectively which were significantly lower than that of negative and minimal categories (p = 0.053). In multivariate analysis, age at the time of diagnosis, pulmonary, bone metastases and extensive [18F]FDG PET/CT volume of lesions were the independent factor predicting PFS. Bone metastasis was only the factor could predict OS in multivariate analysis. The minimal and negative [18F]FDG PET/CT categories had better prognosis than extensive category in PFS and OS. Extensive [18F]FDG PET/CT category was an independent factor for predicting PFS. Bone metastasis was only the independent factor that could predict both PFS and OS.

Ha LN ，Phuong NT ，Son MH 《BMC Surgery》

Prognostic value of metabolic tumor volume on [(18)F]FDG PET/CT in addition to the TNM classification system of locally advanced non-small cell lung cancer.

Staging of non-small cell lung cancer (NSCLC) is commonly based on [18F]FDG PET/CT, in particular to exclude distant metastases and guide local therapy approaches like resection and radiotherapy. Although it is hoped that PET/CT will increase the value of primary staging compared to conventional imaging, it is generally limited to the characterization of TNM. The first aim of this study was to evaluate the PET parameter metabolic tumor volume (MTV) above liver background uptake as a prognostic marker in lung cancer. The second aim was to investigate the possibility of incorporating MTV into the TNM classification system for disease prognosis in locally advanced NSCLC treated with chemoradiotherapy. Retrospective evaluation of 235 patients with histologically proven, locally advanced NSCLC from the multi-centre randomized clinical PETPLAN trial and a clinical cohort from a hospital registry. The PET parameters SUVmax, SULpeak, MTV and TLG above liver background uptake were determined. Kaplan-Meier curves and stratified Cox proportional hazard regression models were used to investigate the prognostic value of PET parameters and TNM along with clinical variables. Subgroup analyses were performed to compare hazard ratios according to TNM, MTV, and the two variables combined. In the multivariable Cox regression analysis, MTV was associated with significantly worse overall survival independent of stage and other prognostic variables. In locally advanced disease stages treated with chemoradiotherapy, higher MTV was significantly associated with worse survival (median 17 vs. 32 months). Using simple cut-off values (45 ml for stage IIIa, 48 ml for stage IIIb, and 105 ml for stage IIIc), MTV was able to further predict differences in survival for stages IIIa-c. The combination of TNM and MTV staging system showed better discrimination for overall survival in locally advanced disease stages, compared to TNM alone. Higher metabolic tumor volume is significantly associated with worse overall survival and combined with TNM staging, it provides more precise information about the disease prognosis in locally advanced NSCLC treated with chemoradiotherapy compared to TNM alone. As a PET parameter with volumetric information, MTV represents a useful addition to TNM.

Brose A ，Miederer I ，König J ，Gkika E ，Sahlmann J ，Schimek-Jasch T ，Schreckenberger M ，Nestle U ，Kappes J ，Miederer M ... -  《-》

Prognostic Importance of (18)F-FDG Positron Emission Tomography in Uterine Cervical Cancer.

The aim of this study was to evaluate the prognostic value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the uterine cervix cancer patients. Thirty-two women (mean age: 52.7±12.6) who underwent 18F-FDG PET/CT for staging of uterine cervix cancer were retrospectively recruited for the study. Maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors, lymph nodes, and distant metastases were calculated from 18F-FDG PET/CT images using the 40% threshold. Patients were divided into groups according to the presence of pelvic and para-aortic lymph node involvement on 18F-FDG PET/CT images. Life tables and Kaplan-Meier analyses were performed to compare the mean survival times of the different groups. Primary tumor of 27 (84%) patients were 18F-FDG avid. The median SUVmax, SUVmean, MTV, and TLG of the primary tumors were 12.4, 6.1, 13.2 cm3 and 87.8 g/mL x cm3 respectively. Pathological uptake was detected in pelvic 14 (44%) patients and in paraaortic lymph nodes in 3 (10%) para-aortic lymph nodes. The median whole-body MTV and TLG were 21.7 cm3 and 91.1 g/mL x cm3. Disease progression was detected in 7 (22%) patients within a median follow-up period of 20.9 (minimum-maximum: 3-82) months. The only significant PET parameter to predict progression-free survival was SUVmax in the primary tumor (p=0.038). During follow-up period 8 patients died. SUVmax (p=0.007), MTV (p=0.036), TLG (p=0.001) of primary tumor, presence of pathological uptake on pelvic or paraaortic lymph nodes (p=0.015), whole-body MTV (p=0.047) and whole-body TLG (p=0.001) were found statistically significant PET parameters to predict overall survival. Metabolic parameters of primary tumors derived from 18F-FDG PET/CT images have prognostic importance for patients with uterine cervical carcinoma. In patients with metastatic disease, higher whole-body MTV and TLG are also associated with poor prognosis.

Soydal Ç ，Baltacıoğlu MH ，Araz M ，Demir B ，Dursun E ，Taşkın S ，Küçük NÖ ，Ortaç F ... -  《-》

Prognostic Role of Pretreatment Tumor Burden and Dissemination Features From 2-[(18)F]FDG PET/CT in Advanced Mantle Cell Lymphoma.

Mantle cell lymphoma (MCL) is an aggressive non-Hodgkin lymphoma with poor prognosis. The usefulness of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) and its parameters in the evaluation of treatment response and prognosis is not yet clear. The aim of this study was to investigate the prognostic role of tumor burden and tumor dissemination features derived by 2-[18F]FDG PET/CT in advanced MCL. We retrospectively included 120 patients with advanced MCL who underwent baseline 2- 2-[18F]FDG PET/CT and end-of-treatment (eot) PET/CT. The baseline-PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and dissemination features (Dmax and Dmax-bsa). EotPET/CT was judged according to the Lugano classification. Progression-free survival (PFS) and overall survival (OS) were plotted according to the Kaplan-Meier method. At a median follow-up of 59 months, relapse/progression occurred in 68 patients while death in 38 patients with a median PFS and OS of 27.2 and 57.6 months, respectively. MIPI score, Bulky disease, Ki-67 index, metabolic response, pretreatment MTV and TLG were significantly associated with PFS at univariate analysis, but only metabolic response, MTV and TLG were confirmed to be independent prognostic factors. Considering OS, only dissemination features were demonstrated to be prognostic features. In conclusions, metabolic response and metabolic tumor burden parameters (MTV and TLG) are strongest predictor of PFS, while dissemination features may have a significant role for predicting OS.

Albano D ，Bianchetti N ，Talin A ，Dondi F ，Re A ，Tucci A ，Bertagna F ... -  《-》