Development and validation of a prediction model based on the organ-based metabolic tumor volume on FDG-PET in patients with differentiated thyroid carcinoma

Abstract

Background: Although patients with differentiated thyroid cancer (DTC) generally have a good prognosis, patients with a large metabolic tumor volume (MTV) on FDG-PET may experience poor clinical courses. We measured organ-based MTVs and tested its prognostic performance in comparison to conventional MTV (cMTV). Methods: We retrospectively analyzed the cases of 280 patients who received their first I-131 therapy in 2003-2014 at our hospital and showed an FDG-avid metastatic lesion. We randomly divided the patients into training (n=190) and validation (n=90) datasets. We classified the MTVs as MTVneck-node, MTVdistant-node, MTVlung, MTVbone, and MTVother-organs and tested with/without dichotomization vis-à-vis overall survival (OS). Based on the estimated weighting coefficients of the organ-based MTVs, we propose a new index: the adjusted whole-body MTV (aMTV). Using the validation dataset, we compared the aMTV with cMTV for predicting OS. Results:In a univariate analysis, MTVdistant-node and MTVother-organs were more strongly correlated with the OS than the dichotomized forms, whereas the dichotomized forms of MTVneck-node, MTVlung, and MTVbone were more strongly correlated with OS than the continuous variables. The aMTV was thus expressed as 0.69 × dic(MTVneck-node) + 0.02 × MTVdistant-node + 1.05 × dic(MTVlung) + 1.58 × dic(MTVbone) + 0.01 × MTVother-organs, where dic(x) represents 0 or 1 based on the optimized cut-off. In the model evaluation using the validation group, aMTV was a significant predictor of OS with a higher c-index (0.7676) than cMTV (0.7218). Conclusion:In DTC patients with FDG-avid metastasis before I-131 therapy, all organ-based MTVs were significant predictors of prognosis. As the aMTV outperformed the cMTV for predicting prognoses, we recommend measuring the MTV on an organ basis.4

Present and future of target therapies and theranostics: refining traditions and exploring new frontiers—highlights from annals of Nuclear Medicine 2021

“…The identification of novel prognostic factors, including molecular and imagederived biomarkers, is ongoing with the goal of improving risk stratification and patients' management. In this regard, papers published by Ledwon et al [4], Konishi et al [6], Albano et al [7], Takata et al [8] and Uchiyama et al [9] provided insightful promising results.…”

“…Uchiyama et al [9] established a prediction model based on organ-based metabolic tumour volume (MTV) in DTC patients with [ 18 F]FDG-avid metastatic lesions treated with iodine-131. The prognostic stratification of the organ-based MTV, establishing the adjusted whole-body MTV calculated by giving a different weight according to the organ of spread, outperformed conventional MTV models.…”

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

“…18 F-FDG PET/CT has emerged as a more valuable diagnostic tool than ultrasound and/or CT for detecting and localizing recurrence and metastases in TENIS syndrome, with high sensitivity and speci city (4)(5)(6). In addition, metabolic features of 18 F-FDG PET/CT may predict prognosis and outcome (7)(8)(9). Recently, a systemic review by Wang H et. al suggested that certain semi-quantitative parameters such as standard uptake value (SUV)max, SUVpeak, metabolic volume (MTV) and total lesion glycolysis (TLG) alone or combination with other variables could serve as prognostic markers to predict poor outcome in TENIS syndrome (10).…”

Maximum standardized uptake value in 11C-methionine positron emission tomography may predict the prognosis of patients with oral squamous cell carcinoma

“…18 F-uorodeoxyglucose (FDG)-PET is widely used clinically for tumor imaging due to increased glucose metabolism in many tumor types, including OSCC [3,4]. In theory, cancer with a high uptake of FDG indicates more aggressive behavior, resulting in poor prognosis of patients [5]. However, whether or not FDG-uptake parameters, including the maximum standardized uptakes value (SUV max ), can predict the prognosis of OSCC patients remains controversial [4].…”