术前氟-18-氟脱氧葡萄糖正电子发射计算机断层扫描（18F-FDG PET）在胸腺上皮瘤（TETs）中被广泛应用于鉴别恶性程度高的TETs，然而，它对确定局部晚期瘤、淋巴结（LN）转移和预后的预测能力尚不明确。我们回顾性评估了2012年1月至2023年1月间经术前18F-FDG PET评估的可切除性TETs患者。使用受试者工作特征曲线评估最大标准摄取值（SUVmax）的截断值以预测晚期疾病。使用Kaplan-Meier方法分析复发/进展无病生存（RFS/PFS）。根据肿瘤-结-转移系统进行分期。 本研究纳入了177例患者；145例（81.9%）为病理早期TET（I期或II期），32例（19.1%）为晚期（III期或IV期）。预测晚期的曲线下面积值为0.903，截断值为5.6（敏感性81.3%，特异性84.8%）。SUVmax > 5.6与RFS/PFS的预后较差相关。FDG摄取在30.8%的LN阳性患者中术前检测到LN转移，而SUVmax < 5.9的患者中未病理检测到LN转移。在晚期TET患者中，术前被18F-FDG PET检测到的LN复发比未被检测到的患者更频繁（75.0%对7.1%）。 18F-FDG PET是一种预测TETs晚期和预后差的潜在有价值的工具。SUVmax可以帮助胸外科医生在选择适当的TETs治疗策略方面提供指导。 © 2023. Society of Surgical Oncology.

Preoperative fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) of thymic epithelial tumors (TETs) is well known for identifying malignant-grade TETs; however, its predictive power for determining locally advanced tumors, lymph node (LN) metastasis, and prognosis remains unknown.We retrospectively evaluated patients with resectable TETs who were preoperatively assessed using 18F-FDG PET from January 2012 to January 2023. The receiver operating characteristic curve was used to evaluate the cutoff value of the maximum standardized uptake value (SUVmax) to predict advanced-stage disease. Recurrence/progression-free survival (RFS/PFS) was analyzed using the Kaplan-Meier method. The staging was classified according to the tumor-node-metastasis system.Our study included 177 patients; 145 (81.9%) had pathological early-stage TET (stage I or II), and 32 (19.1%) had advanced stage (stage III or IV). The area under the curve value for predicting the advanced stage was 0.903, and the cutoff value was 5.6 (sensitivity 81.3%, specificity 84.8%). SUVmax > 5.6 was associated with worse prognosis for RFS/PFS. LN metastasis was preoperatively detected by FDG uptake in 30.8% of patients with pathological LN positivity, whereas LN metastasis was not pathologically detected in patients with SUVmax < 5.9. In patients with advanced-stage TETs, LN recurrence was more frequent in patients who were preoperatively detected by 18F-FDG PET than those who were not (75.0% versus 7.1%).18F-FDG PET is a potentially valuable tool for predicting advanced stage and poor prognosis of recurrence in patients with TETs. SUVmax can help thoracic surgeons to guide them in selecting appropriate therapeutic strategies for TETs.© 2023. Society of Surgical Oncology.