Clinical outcomes by bone metastasis uptake pattern in differentiated thyroid cancer.
Patients with differentiated thyroid cancer (DTC) and bone metastases (BM) exhibit heterogeneous radioactive iodine (RAI) and fluorine-18-fluorodeoxyglucose (18F-FDG) uptake patterns at diagnosis. This study is aimed to evaluate clinical outcomes influenced these distinct uptake patterns.
Patients confirmed DTC with BM were involved in this study between 2006 and 2021. All patients received 131I treatment and performed 18F-FDG positron emission tomography with computed tomography (PET/CT) at diagnosis. Variables including patient's gender, age, pathology, laboratory examination, uptake pattern of bone lesions, treatment protocols, and metabolic parameters of PET/CT were analyzed for the prognosis.
Among 67 enrolled DTC patients with BM, three uptake patterns were identified: RAI+/PET- (18 patients, 26.9%), RAI+/PET+ (40 patients, 59.7%), and RAI-/PET+ (9 patients, 13.4%). Univariate analysis revealed that age stratification, serum thyroglobulin (Tg) levels, and BM uptake pattern significantly impacted progression-free survival (PFS) and overall survival (OS). Critically, RAI+/PET + patients with RAI(+) ratio > 50% showed better PFS (range 12-156 months, median 38.5 months, p = 0.000) and OS (range 20-156 months, median 61.5 months, and p = 0.012) than those with RAI(+) ratio [Formula: see text]50% (PFS: range 6-92months, median 24 months; OS: range 28-112 months, median 51 months). Multivariate analysis identified total total lesion glycolysis of all bone lesions (tTLG) from PET/CT as an independent prognostic factor for both PFS and OS (p = 0.021 and p = 0.035, respectively).
The RAI(+) ratio determines clinical outcomes, and the prognosis of RAI+/PET + patients resembles that of RAI+/PET- patients, suggesting similar biological behavior in DTC patients with BM. Pretreatment tTLG is a significant independent prognostic marker for PFS and OS.
Patients confirmed DTC with BM were involved in this study between 2006 and 2021. All patients received 131I treatment and performed 18F-FDG positron emission tomography with computed tomography (PET/CT) at diagnosis. Variables including patient's gender, age, pathology, laboratory examination, uptake pattern of bone lesions, treatment protocols, and metabolic parameters of PET/CT were analyzed for the prognosis.
Among 67 enrolled DTC patients with BM, three uptake patterns were identified: RAI+/PET- (18 patients, 26.9%), RAI+/PET+ (40 patients, 59.7%), and RAI-/PET+ (9 patients, 13.4%). Univariate analysis revealed that age stratification, serum thyroglobulin (Tg) levels, and BM uptake pattern significantly impacted progression-free survival (PFS) and overall survival (OS). Critically, RAI+/PET + patients with RAI(+) ratio > 50% showed better PFS (range 12-156 months, median 38.5 months, p = 0.000) and OS (range 20-156 months, median 61.5 months, and p = 0.012) than those with RAI(+) ratio [Formula: see text]50% (PFS: range 6-92months, median 24 months; OS: range 28-112 months, median 51 months). Multivariate analysis identified total total lesion glycolysis of all bone lesions (tTLG) from PET/CT as an independent prognostic factor for both PFS and OS (p = 0.021 and p = 0.035, respectively).
The RAI(+) ratio determines clinical outcomes, and the prognosis of RAI+/PET + patients resembles that of RAI+/PET- patients, suggesting similar biological behavior in DTC patients with BM. Pretreatment tTLG is a significant independent prognostic marker for PFS and OS.