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유두상 갑상선암에서 PET/CT의 F-18 FDG 섭취와 BRAFV600E mutation의 연관성

Relation between F-18 FDG Uptake of PET/CT and BRAFV600E Mutation in Papillary Thyroid Cancer

초록/요약

목적: BRAFV600E mutation과 F-18 fluorodeoxyglucose (FDG) 섭취는 유두상 갑상선암 (papillary thyroid cancer, PTC)의 잠재적인 예후인자이다. 본 연구는 유두상 감상선암에서 BRAFV600E mutation과 F-18 FDG 섭취의 연관성을 조사하기 위하여 시행되었다. 방법: 2009년 9월부터 2012년 8월까지 갑상선 전절제술을 받기 전에 positron emission tomography/computed tomography (PET/CT)를 시행받은 169명의 갑상선 유두상암 환자를 대상으로 후향적인 연구를 시행하였다. 대상자는 over PTC (> 1 cm, n = 76)와 papillary thyroid microcarcinoma (PTMC, n = 93)의 두 집단으로 분류하였다. 원발성 종양의 maximum standardized uptake value (SUVmax)와 임상적, 병리학적 변수들의 관계를 조사하기 위하여 단변량 분석과 다변량 분석을 시행하였다. 결과: BRAFV600E mutation은 82.2% (139/169)의 환자에서 발견되었다. 다변량 분석상 모든 대상자들에서 BRAFV600E mutation (P = 0.048)과 종양 크기 (P < 0.001)는 독립적으로 SUVmax와 유의한 연관성을 보였다. SUVmax는 wild-type BRAF인 종양에서보다 BRAFV600E mutation인 종양에서 유의하게 높았다 (9.4 ± 10.9 vs. 5.0 ± 4.1, P < 0.001). Overt PTC 집단에서 BRAFV600E mutation (P = 0.032)과 종양 크기 (P = 0.001)는 독립적으로 SUVmax와 유의한 연관성을 보였다. 그러나 PTMC 집단에서는 종양 크기만이 SUVmax와 유의한 연관성을 보였다 (P = 0.010). 결론: 크기가 1 cm보다 큰 유두상 갑상선암에서 BRAFV600E mutation의 존재는 수술 전 PET/CT상 높은 F-18 FDG 섭취와 독립적으로 유의한 연관성을 보였으나, 1 cm보다 작은 유두상 갑상선암에서는 유의한 연관성을 보이지 않았다. 본 연구는 유두상 갑상선암 환자에서 BRAFV600E mutation과 F-18 FDG 섭취의 연관성에 대한 증거를 제시하였다.

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초록/요약

Purpose: BRAFV600E mutation and F-18 fluorodeoxyglucose (FDG) uptake are potential prognostic factors of papillary thyroid cancer (PTC). This study was performed to investigate the relationship between the BRAFV600E mutation and F-18 FDG uptake in PTC. Materials and Methods: We retrospectively included 169 PTC patients who underwent F-18 FDG positron emission tomography/computed tomography (PET/CT) before thyroidectomy from May 2009 to August 2012. Subjects were classified into overt PTC (> 1 cm, n = 76) and papillary thyroid microcarcinoma (PTMC, n = 93) groups. Univariate and multivariate analyses were performed to assess the relationship between maximum standardized uptake value (SUVmax) of the primary tumor and clinicopathologic variables. Results: The BRAFV600E mutation was detected in 82.2% (139/169). In all subjects, the BRAFV600E mutation and tumor size were independently related to SUVmax by multivariate analysis (P = 0.048 and P < 0.001, respectively). SUVmax was significantly higher in tumors with the BRAFV600E mutation than in those with wild-type BRAF (9.4 ± 10.9 vs. 5.0 ± 4.1, P < 0.001). Similarly, in overt PTC group, the BRAFV600E mutation and tumor size were independently correlated with SUVmax (P = 0.032 and P = 0.001, respectively). By contrast, in PTMC group, only tumor size was significantly associated with SUVmax (P = 0.010). Conclusions: The presence of the BRAFV600E mutation is independently associated with high F-18 FDG uptake on preoperative PET/CT in patients with overt PTC, but this relationship was not evident in PTMC. This study provides a better understanding of the relationship between F-18 FDG uptake and BRAFV600E mutation in patients with PTC.

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목차

Ⅰ. INTRODUCTION 1
Ⅱ. MATERIALS AND METHODS 3
A. Patients 3
B. F-18 FDG PET/CT and Image Analysis 3
C. BRAFV600E Mutation Analysis 4
D. Statistical Analysis 5
Ⅲ. RESULTS 6
A. Patients’ Characteristics 6
B. Relationships between SUVmax and Clinicopathologic Variables in All Patients with PTC 6
C. Relationships between SUVmax and Clinicopathologic Variables in All Patients with Overt PTC 7
D. Relationships between SUVmax and Clinicopathologic Variables in All Patients with PTMC 8
Ⅳ. DISCUSSION 13
Ⅴ. CONCLUSION 17
REFERENCES 18
국문요약 23

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