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Purpose <p>The aim of this study is to investigate the impact of lymph node metastases (LNM) detected on cervical <sup>131</sup>I single photon emission computed tomography/computed tomography (SPECT/CT) after the first radioiodine therapy (RAI) on complete response (CR) and progression-free survival (PFS) in patients with differentiated thyroid cancer (DTC).</p> Methods <p>This retrospective study included 942 DTC patients who underwent cervical <sup>131</sup>I SPECT/CT after their first RAI. LNM were categorized based on CT (enlarged ≥ 1&#xa0;cm, small &lt; 1&#xa0;cm) and <sup>131</sup>I uptake. CR and PFS were analysed using Kaplan–Meier curves and Cox regression.</p> Results <p>Patients with no LNM had a shorter median time to CR (9.4&#xa0;months) than those with LNM (44&#xa0;months, HR 2.2; <i>p</i> &lt; 0.01) and a lower risk of progression (median PFS not reached, HR 0.46; <i>p</i> &lt; 0.01). Among patients with LNM, those with enlarged <sup>131</sup>I negative LNM had the longest time to CR (24&#xa0;months, HR 0.36; <i>p</i> &lt; 0.01). Patients with small LNM had a PFS similar to patients without LNM (median PFS not reached, HR 1.22; <i>p</i> = 0.54). Reoperation after first RAI (13.5&#xa0;months) led to earlier CR than second RAI (median not reached) in patients with enlarged LNM. For small LNM, second RAI was associated with longer PFS than reoperation (38.4&#xa0;months vs. not reached, HR 4.0; <i>p</i> = 0.02).</p> Conclusion <p>Patients without LNM on post-therapy <sup>131</sup>I SPECT/CT have better chances for early CR and longer PFS. Patients with LNM benefit from early reoperations but treatment strategies should be tailored based on LNM characteristics.</p>

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131I SPECT/CT provides prognostic information in patients with differentiated thyroid cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月15日

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  • Marieke Heinrich,
  • Elias Blickle,
  • Philipp E. Hartrampf,
  • Natalie Hasenauer,
  • Aleksander Kosmala,
  • Alexander Kerscher,
  • Nicolas Schlegel,
  • Frederik A. Verburg,
  • Andreas K. Buck,
  • Kerstin Michalski

摘要

Purpose

The aim of this study is to investigate the impact of lymph node metastases (LNM) detected on cervical 131I single photon emission computed tomography/computed tomography (SPECT/CT) after the first radioiodine therapy (RAI) on complete response (CR) and progression-free survival (PFS) in patients with differentiated thyroid cancer (DTC).

Methods

This retrospective study included 942 DTC patients who underwent cervical 131I SPECT/CT after their first RAI. LNM were categorized based on CT (enlarged ≥ 1 cm, small < 1 cm) and 131I uptake. CR and PFS were analysed using Kaplan–Meier curves and Cox regression.

Results

Patients with no LNM had a shorter median time to CR (9.4 months) than those with LNM (44 months, HR 2.2; p < 0.01) and a lower risk of progression (median PFS not reached, HR 0.46; p < 0.01). Among patients with LNM, those with enlarged 131I negative LNM had the longest time to CR (24 months, HR 0.36; p < 0.01). Patients with small LNM had a PFS similar to patients without LNM (median PFS not reached, HR 1.22; p = 0.54). Reoperation after first RAI (13.5 months) led to earlier CR than second RAI (median not reached) in patients with enlarged LNM. For small LNM, second RAI was associated with longer PFS than reoperation (38.4 months vs. not reached, HR 4.0; p = 0.02).

Conclusion

Patients without LNM on post-therapy 131I SPECT/CT have better chances for early CR and longer PFS. Patients with LNM benefit from early reoperations but treatment strategies should be tailored based on LNM characteristics.