Increased thyroid uptake on 18F-FDG PET/CT is associated with the development of permanent hypothyroidism in stage IV me
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ORIGINAL ARTICLE
Increased thyroid uptake on 18F‑FDG PET/CT is associated with the development of permanent hypothyroidism in stage IV melanoma patients treated with anti‑PD‑1 antibodies Alexandra Frelau1 · Xavier Palard‑Novello2 · Eva Jali3 · Lise Boussemart4 · Alain Dupuy4 · Pandora James5 · Anne Devillers2 · Florence Le Jeune2 · Julien Edeline1 · Thierry Lesimple1 · Antoine Girard2 Received: 22 April 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To determine performances of 2-deoxy-2-(18F)fluoro-d-glucose (18F-FDG) positron emission tomography (PET) to detect the development of permanent thyroid dysfunction (PTD), and to evaluate the prognostic value of early increased thyroid uptake in stage IV melanoma patients treated with anti-programmed death 1 (anti-PD-1) antibodies. Methods Twenty-nine patients were retrospectively enrolled. PTD was defined as symptomatic thyroid disorder requiring long-term specific treatment. On the first PET performed during follow-up, maximal standardized uptake value of the thyroid (SUVmax-Th) and SUVmax-Th/SUVmax-blood-pool ratio (Th/B) were measured. Areas under ROC curves (AUC) of these parameters for the diagnostic of PTD were compared. Cutoff values were defined to maximize the Youden’s index. Survival analyses were performed according to the Kaplan–Meier method and compared using the log-rank method between patients with and without enhanced thyroid uptake according to cutoff values defined with the Hothorn and Lausen method. Results Four patients presented PTD. Median SUVmax-Th and Th/B were, respectively, 2.11 and 1.00. The median followup period was 21.7 months. AUC were 1.0 (CI95% 0.88–1.0) for both parameters. Optimal cutoff values were, respectively, SUVmax-Th > 4.1 and Th/B > 2.0, both conferring sensitivities of 100% (CI95% 40–100%) and specificities of 100% ( CI95% 86–100%). The median progression-free survival and overall survival were 11.3 months and 33.5 months, respectively. Using optimized cutoffs, there was no statistically significant difference of survival. Conclusion SUVmax-Th > 4.1 and Th/B > 2.0 provided perfect diagnostic performances to detect patients that developed PTD. No significant survival difference was found between patients with and without increased thyroid uptake. Keywords 18F-FDG PET/CT · Metastatic melanoma · Anti-PD-1 antibodies · Thyroid · Immune-related adverse events · Immune checkpoint inhibitors Abbreviations 18F-FDG 2-Deoxy-2-(18F)fluoro-d-glucose AJCC American joint committee of cancer Anti-PD-1 Anti-programmed death 1 antibodies Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00262-020-02712-7) contains supplementary material, which is available to authorized users. * Antoine Girard [email protected] 1
Department of Oncology, Eugène Marquis Center, Rennes, France
Department of Nuclear Medicine, Eugène Marquis Center, Avenue de La Bataille Flandres-Dunkerque, 35000 Rennes, France
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