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甲状腺癌的发病率及晚期病死率逐年升高[1-2]。DTC作为一种最常见的甲状腺癌,发病率在所有甲状腺癌中高达95%以上,其主要包括甲状腺乳头状癌(papillary carcinoma of thyroid,PTC)和甲状腺滤泡状癌[3]。大多数DTC患者经手术、131I内照射治疗或TSH抑制治疗后预后较好,但仍有23%的患者会发生远处转移[4],其中约1/3发生失分化,最终发展为放射性碘难治性分化型甲状腺癌(radioactive iodine-refractory differentiated thyroid cancer,RAIR-DTC)[5]。RAIR-DTC患者的预后较差,平均生存期仅为3~5年,10年生存率仅为10%[3]。目前靶向前列腺特异性膜抗原(prostate specific membrane antigen,PSMA)的药物已用于前列腺癌患者的诊断及治疗,且不良反应少[6]。而PSMA并非只在前列腺中特异性表达,Verburg等[7]和Verma等[8]进行的68Ga-PSMA PET/CT显像研究结果显示,DTC患者的PSMA表达水平同样较高;Ciappuccini等[9]开展的免疫组织化学研究结果也证实了DTC患者血管内皮细胞中有PSMA表达,且RAIR-DTC患者中PSMA表达水平更高。这表明18F-PSMA PET有望成为RAIR-DTC患者新的诊断方法,但目前对RAIR-DTC患者进行18F-PSMA PET/CT显像的研究较少。本文中我们对1例索拉非尼靶向治疗耐药的RAIR-DTC患者行18F-PSMA PET/CT显像,评估其在适合进行放射性核素标记PSMA靶向治疗的患者筛选中的价值,旨在为RAIR-DTC患者提供新的诊断和治疗方法。
放射性碘难治性分化型甲状腺癌18F-PSMA PET/CT显像1例
18F-PSMA PET/CT imaging of radioactive iodine-refractory differentiated thyroid cancer: a case report
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摘要: 笔者报道了1例放射性碘难治性分化型甲状腺癌(RAIR-DTC)患者,分别从临床病史、18F-前列腺特异性膜抗原(PSMA) PET/CT显像方面分析了RAIR-DTC 的特点。RAIR-DTC预后较差,诊断及治疗方法有限。目前18F-PSMA PET/CT显像用于RAIR-DTC患者诊断的研究较少。笔者对1例RAIR-DTC患者行18F-PSMA PET/CT显像,以期为RAIR-DTC患者提供新的诊断及治疗方法。Abstract: The authors reported a case of radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC). The characteristics of RAIR-DTC were analyzed from the aspects of clinical history and 18F-prostate specific membrane antigen (PSMA) PET/CT imaging. RAIR-DTC has a poor prognosis, and the diagnostic and therapeutic methods are limited. At present, there are few studies on 18F-PSMA PET/CT imaging in the diagnosis of RAIR-DTC patients. The authors performed 18F-PSMA PET/CT imaging on a patient with RAIR-DTC, in order to provide new diagnostic and therapeutic methods for patients with RAIR-DTC.
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[1] Miranda-Filho A, Lortet-Tieulent J, Bray F, et al. Thyroid cancer incidence trends by histology in 25 countries: a population-based study[J]. Lancet Diabetes Endocrinol, 2021, 9(4): 225−234. DOI: 10.1016/s2213-8587(21)00027-9. [2] Megwalu UC, Moon PK. Thyroid cancer incidence and mortality trends in the United States: 2000-2018[J]. Thyroid, 2022, 32(5): 560−570. DOI: 10.1089/thy.2021.0662. [3] 中华医学会核医学分会. 131I治疗分化型甲状腺癌指南(2021版)[J]. 中华核医学与分子影像杂志, 2021, 41(4): 218−241. DOI: 10.3760/cma.j.cn321828-20201113-00412.
Chinese Society of Nuclear Medicine. Guidelines for radioiodine therapy of differentiated thyroid cancer (2021 edition)[J]. Chin J Nucl Med Mol Imaging, 2021, 41(4): 218−241. DOI: 10.3760/cma.j.cn321828-20201113-00412.[4] Berdelou A, Lamartina L, Klain M, et al. Treatment of refractory thyroid cancer[J]. Endocr Relat Cancer, 2018, 25(4): R209−R223. DOI: 10.1530/erc-17-0542. [5] Schlumberger M, Brose M, Elisei R, et al. Definition and management of radioactive iodine-refractory differentiated thyroid cancer[J]. Lancet Diabetes Endocrinol, 2014, 2(5): 356−358. DOI: 10.1016/s2213-8587(13)70215-8. [6] Wang FJ, Li ZF, Feng XQ, et al. Advances in PSMA-targeted therapy for prostate cancer[J]. Prostate Cancer Prostatic Dis, 2022, 25(1): 11−26. DOI: 10.1038/s41391-021-00394-5. [7] Verburg FA, Krohn T, Heinzel A, et al. First evidence of PSMA expression in differentiated thyroid cancer using [68Ga]PSMA-HBED-CC PET/CT[J]. Eur J Nucl Med Mol Imaging, 2015, 42(10): 1622−1623. DOI: 10.1007/s00259-015-3065-y. [8] Verma P, Malhotra G, Agrawal R, et al. Evidence of prostate-specific membrane antigen expression in metastatic differentiated thyroid cancer using 68Ga-PSMA-HBED-CC PET/CT[J]. Clin Nucl Med, 2018, 43(8): e265−e268. DOI: 10.1097/RLU.0000000000002161. [9] Ciappuccini R, Saguet-Rysanek V, Giffard F, et al. PSMA expression in differentiated thyroid cancer: association with radioiodine, 18FDG uptake, and patient outcome[J]. J Clin Endocrinol Metab, 2021, 106(12): 3536−3545. DOI: 10.1210/clinem/dgab563. [10] Evans JC, Malhotra M, Cryan JF, et al. The therapeutic and diagnostic potential of the prostate specific membrane antigen/glutamate carboxypeptidase Ⅱ (PSMA/GCPⅡ) in cancer and neurological disease[J]. Br J Pharmacol, 2016, 173(21): 3041−3079. DOI: 10.1111/bph.13576. [11] Uijen MJM, Derks YHW, Merkx RIJ, et al. PSMA radioligand therapy for solid tumors other than prostate cancer: background, opportunities, challenges, and first clinical reports[J]. Eur J Nucl Med Mol Imaging, 2021, 48(13): 4350−4368. DOI: 10.1007/s00259-021-05433-w. [12] Kuten J, Fahoum I, Savin Z, et al. Head-to-head comparison of 68Ga-PSMA-11 with 18F-PSMA-1007 PET/CT in staging prostate cancer using histopathology and immunohistochemical analysis as a reference standard[J]. J Nucl Med, 2020, 61(4): 527−532. DOI: 10.2967/jnumed.119.234187. [13] Taywade SK, Damle NA, Bal C. PSMA expression in papillary thyroid carcinoma: opening a new horizon in management of thyroid cancer?[J]. Clin Nucl Med, 2016, 41(5): e263−e265. DOI: 10.1097/rlu.0000000000001148. [14] Lengana T, Lawal IO, Mokoala K, et al. 68Ga-PSMA: a one-stop shop in radioactive iodine refractory thyroid cancer?[J]. Nucl Med Mol Imaging, 2019, 53(6): 442−445. DOI: 10.1007/s13139-019-00621-x. [15] Sasikumar A, Joy A, Pillai MRA, et al. Rare case of intratracheal metastasis detected on 68Ga-prostate-specific membrane antigen PET/CT scan in a case of thyroglobulin elevated negative iodine scan syndrome[J]. Clin Nucl Med, 2018, 43(4): 282−283. DOI: 10.1097/rlu.0000000000001992. [16] Hofman MS, Violet J, Hicks RJ, et al. [177Lu]-PSMA-617 radionuclide treatment in patients with metastatic castration-resistant prostate cancer (LuPSMA trial): a single-centre, single-arm, phase 2 study[J]. Lancet Oncol, 2018, 19(6): 825−833. DOI: 10.1016/s1470-2045(18)30198-0. [17] de Vries LH, Lodewijk L, Braat AJAT, et al. 68Ga-PSMA PET/CT in radioactive iodine-refractory differentiated thyroid cancer and first treatment results with 177Lu-PSMA-617[J/OL]. EJNMMI Res, 2020, 10(1): 18[2023-06-24]. https://ejnmmires.springeropen.com/articles/10.1186/s13550-020-0610-x. DOI: 10.1186/s13550-020-0610-x. [18] Assadi M, Ahmadzadehfar H. 177Lu-DOTATATE and 177Lu-prostate-specific membrane antigen therapy in a patient with advanced metastatic radioiodine-refractory differentiated thyroid cancer after failure of tyrosine kinase inhibitors treatment[J]. World J Nucl Med, 2019, 18(4): 406−408. DOI: 10.4103/wjnm.WJNM_112_18.