Subject(s)
Resuscitation/methods , Shock, Hemorrhagic , Wounds and Injuries , Animals , Humans , Shock, Hemorrhagic/diagnosis , Shock, Hemorrhagic/etiology , Shock, Hemorrhagic/therapy , Trauma Severity Indices , Wounds and Injuries/complications , Wounds and Injuries/diagnosis , Wounds and Injuries/therapyABSTRACT
CONTEXT/OBJECTIVE: Approximately 15% of thyroid cancer patients develop subsequent metastases. The clinical course of patients with metastatic thyroid carcinoma is highly variable. We hypothesized that the metabolic activity of metastatic lesions, as defined by retention of 2-[(18)F]fluoro-2-deoxyglucose (FDG), would correlate with prognosis. DESIGN/PATIENTS: The initial FDG-positron emission tomography (PET) scans from 400 thyroid cancer patients were retrospectively reviewed and compared with overall survival (median follow-up, 7.9 yr). We examined the prognostic value of clinical information such as gender, age, serum thyroglobulin, American Joint Committee on Cancer (AJCC) stage, histology, radioiodine avidity, FDG-PET positivity, number of FDG-avid lesions, and the glycolytic rate of the most active lesion. RESULTS: Age, initial stage, histology, thyroglobulin, radioiodine uptake, and PET outcomes all correlated with survival by univariate analysis. However, only age and PET results continued to be strong predictors of survival under multivariate analysis. The initial American Joint Committee on Cancer stage was not a significant predictor of survival by multivariate analysis. There were significant inverse relationships between survival and both the glycolytic rate of the most active lesion and the number of FDG-avid lesions. CONCLUSIONS: FDG-PET scanning is a simple, expensive, but powerful means to restage thyroid cancer patients who develop subsequent metastases, assigning them to groups that are either at low (FDG negative) or high (FDG positive) risk of cancer-associated mortality. We propose that the aggressiveness of therapy for metastases should match the FDG-PET status.
Subject(s)
Carcinoma, Papillary, Follicular/diagnostic imaging , Fluorodeoxyglucose F18 , Radiopharmaceuticals , Thyroid Neoplasms/diagnostic imaging , Adult , Age Factors , Carcinoma, Papillary, Follicular/blood , Carcinoma, Papillary, Follicular/metabolism , Carcinoma, Papillary, Follicular/pathology , Female , Fluorodeoxyglucose F18/pharmacokinetics , Humans , Iodine Radioisotopes , Male , Middle Aged , Multivariate Analysis , Neoplasm Metastasis , Positron-Emission Tomography/methods , Predictive Value of Tests , Radiopharmaceuticals/pharmacokinetics , Sex Factors , Survival Analysis , Thyroglobulin/blood , Thyroid Neoplasms/blood , Thyroid Neoplasms/metabolism , Thyroid Neoplasms/pathology , Thyrotropin/bloodABSTRACT
This study was designed to test the hypothesis that changes in subcutaneous PO2 (PscO2) during progressive hemodilution will reliably predict a "critical point" at which tissue O2 consumption (VO2) becomes dependent on O2 delivery (QO2). Twelve pentobarbital-anesthetized male Sprague-Dawley rats (315-375 g) underwent stepwise exchange of plasma for blood (1.5 ml of plasma for each 1 ml of blood lost). The initial exchange was equal to 25% of the estimated circulatory blood volume, and each subsequent exchange was equal to 10% of the estimated circulatory blood volume. After nine exchanges, the hematocrit (Hct) fell from 42 +/- 1 to 6 +/- 1%. Cardiac output and O2 extraction rose significantly. PscO2 became significantly reduced (P < 0.05) after exchange of 45% of the blood volume (Hct = 16 +/- 1%). VO2 became delivery dependent when QO2 fell below 21 ml x min(-1) x kg body wt(-1) (mean Hct = 13 +/- 1%). Eight control rats undergoing 1:1 blood-blood exchange showed no change in PscO2, pH, HCO3(-), or hemodynamics. Measurement of PscO2 may be a useful guide to monitor the adequacy of QO2 during hemodilution.
