Garin Etienne, Le Jeune Florence, Devillers Anne, Cuggia Marc, de Lajarte-Thirouard Anne-Sophie, Bouriel Catherine, Boucher Eveline, Raoul Jean-Luc
UPRESS EA 3890 and Department of Medical Imaging, Centre E. Marquis, Rennes, France.
J Nucl Med. 2009 Jun;50(6):858-64. doi: 10.2967/jnumed.108.057505. Epub 2009 May 14.
The treatment of metastatic neuroendocrine tumors depends on the aggressiveness of the disease. We wanted to know whether (18)F-FDG PET and somatostatin receptor scintigraphy (SRS) can predict early disease progression and patient survival.
We undertook a prospective study of patients with metastatic neuroendocrine tumor diagnosed between September 2003 and January 2006. After obtaining signed informed consent from the patients, we performed CT, SRS, and (18)F-FDG PET and reviewed histologic data. CT was repeated every 3 mo to assess the risk of early progressive disease (first 6 mo), progression-free survival, and overall survival.
Thirty-eight patients (mean age, 60 +/- 15 y) were included. Histologically, 4 patients had a high-grade and 34 a low-grade tumor. The results of (18)F-FDG PET and SRS were positive in 15 and 27 patients. The 2-y overall survival and progression-free survival were 73% and 45%; 16 patients had early progressive disease. Most (18)F-FDG PET-positive patients had early progressive disease (14/15, vs. 2/23 (18)F-FDG PET-negative patients), and most SRS-negative patients had early progressive disease (9/11, vs. 7/27 SRS-positive patients); (18)F-FDG PET gave excellent negative and positive predictive values of 91% and 93%; (18)F-FDG PET results correlated with progression-free survival (P < 0.001) and overall survival (P < 0.001) even when only low-grade tumors were considered. SRS was associated with progression-free survival (P < 0.001) and overall survival (P < 0.03). At multivariate analysis, only (18)F-FDG PET was predictive of progression-free survival.
(18)F-FDG PET exhibits excellent predictive values for early tumor progression. (18)F-FDG PET and SRS results correlate with progression-free survival and overall survival even for histologically low-grade tumors. These explorations could be included in the initial work-up for metastatic neuroendocrine tumor.
转移性神经内分泌肿瘤的治疗取决于疾病的侵袭性。我们想知道（18）F-FDG PET和生长抑素受体闪烁显像（SRS）是否能预测疾病的早期进展和患者生存情况。
我们对2003年9月至2006年1月期间诊断为转移性神经内分泌肿瘤的患者进行了一项前瞻性研究。在获得患者签署的知情同意书后，我们进行了CT、SRS和（18）F-FDG PET检查，并回顾了组织学数据。每3个月重复进行CT检查，以评估早期疾病进展风险（前6个月）、无进展生存期和总生存期。
纳入38例患者（平均年龄60±15岁）。组织学上，4例为高级别肿瘤，34例为低级别肿瘤。（18）F-FDG PET和SRS检查结果分别在15例和27例患者中呈阳性。2年总生存期和无进展生存期分别为73%和45%；16例患者出现早期疾病进展。大多数（18）F-FDG PET阳性患者出现早期疾病进展（14/15，而（18）F-FDG PET阴性患者为2/23），大多数SRS阴性患者出现早期疾病进展（9/11，而SRS阳性患者为7/27）；（18）F-FDG PET阴性和阳性预测值分别为91%和93%；即使仅考虑低级别肿瘤，（18）F-FDG PET结果也与无进展生存期（P<0.001）和总生存期（P<0.001）相关。SRS与无进展生存期（P<0.001）和总生存期（P<0.03）相关。在多变量分析中，只有（18）F-FDG PET可预测无进展生存期。
（18）F-FDG PET对肿瘤早期进展具有出色的预测价值。即使对于组织学上的低级别肿瘤，（18）F-FDG PET和SRS结果也与无进展生存期和总生存期相关。这些检查可纳入转移性神经内分泌肿瘤的初始检查工作中。
