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This version published online on November 22, 2005
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-1534
A more recent version of this article appeared on February 1, 2006
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Submitted on July 11, 2005
Accepted on November 11, 2005

Real-time Prognosis for Metastatic Thyroid Carcinoma Based on FDG-PET Scanning

Richard J Robbins*, Qiang Wan, Ravinder K Grewal, Roland Reibke, Mithat Gonen, H William Strauss, R Michael Tuttle, William Drucker, and Steven M. Larson

Endocrine, Nuclear Medicine and Biostatistics Services, Departments of Medicine, Radiology and Epidemiology and Biostatistics, Memorial Hospital for Cancer and Allied Diseases, Memorial Sloan-Kettering Cancer Center, New York, NY 10021

* To whom correspondence should be addressed. E-mail: robbinsr{at}mskcc.org.

Context/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-[18F] fluoro-2-deoxyglucose (FDG), would correlate with prognosis.

Design/Patients: The initial FDG-PET scans from 400 thyroid cancer patients were retrospectively reviewed and compared with overall survival (median followup = 7.9 yr). We examined the prognostic value of clinical information such as: gender, age, serum thyroglobulin (Tg), AJCC stage, histology, radioiodine avidity, FDG-PET positivity, number of FDG-avid lesions, and the glycolytic rate of the most active lesion (SUVmax).

Results: Age, initial stage, histology, Tg, 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 AJCC stage was not a significant predictor of survival by multivariate analysis. There were significant inverse relationships between survival and both the SUVmax and the number of FDG-avid lesions.

Conclusions: FDG-PET scanning is a simple, expensive, but powerful means to re-stage 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.
Key words: PET scan • Thyroid Neoplasms • Prognosis • Metastases • Multivariate Analysis • Fluorodeoxyglucose • Radioiodine scan




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