Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet & University of Copenhagen, Copenhagen, Denmark.
European Neuroendocrine Tumors Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark.
J Nucl Med. 2021 Jun 1;62(6):808-815. doi: 10.2967/jnumed.120.244798. Epub 2020 Oct 16.
Accurate grading of patients with neuroendocrine neoplasms (NENs) is essential for risk stratification and optimal choice of therapy. Currently, grading is based on histologically assessed degree of tumor proliferation. The aim of the present study was to assess the long-term prognostic value of F-FDG PET imaging for risk stratification of NENs and compare it with tumor grading (World Health Organization 2010 classification). We conducted a prospective cohort study evaluating the prognostic value of F-FDG PET imaging and compared it with histologic grading. Enrolled were 166 patients of all grades and with histologically confirmed NENs of gastroenteropancreatic origin. The primary endpoint was overall survival (OS). Progression-free survival (PFS) was a secondary endpoint. In addition, OS in relation to peptide receptor radionuclide therapy (PRRT) was analyzed as an exploratory endpoint. The median follow-up time was 9.8 y. Analysis of the whole cohort revealed that a positive F-FDG PET scan was associated with a shorter OS than a negative F-FDG PET scan (hazard ratio: 3.8; 95% CI: 2.4-5.9; < 0.001). In G1 and G2 patients ( = 140), a positive F-FDG PET scan was the only identifier of high risk for death (hazard ratio: 3.6; 95% CI, 2.2-5.9; < 0.001). In multivariate analysis, F-FDG PET, G3 tumor, ≥2 liver metastases, and ≥2 prior therapies were independent prognostic factors for OS, and F-FDG PET, G3 tumor, and ≥3 liver metastases were independent prognostic factors for PFS. For patients receiving PRRT, F-FDG-negative cases had a significantly longer survival than F-FDG-positive cases, whereas no difference was identified for tumor grading. F-FDG-positive patients receiving PRRT had a significantly longer median survival than patients not receiving PRRT (4.4 vs. 1.4 y, = 0.001), whereas no difference was seen for F-FDG-negative patients. F-FDG PET is useful for risk stratification of all NEN grades and is superior to histologic grading. F-FDG PET could differentiate G1 and G2 tumors into low- and high-risk groups. In the selection of therapy and for risk stratification of NEN patients, F-FDG PET status should be considered.
准确的分级对于神经内分泌肿瘤（NENs）的风险分层和最佳治疗方案的选择至关重要。目前，分级基于肿瘤增殖程度的组织学评估。本研究的目的是评估 F-FDG PET 成像在 NENs 风险分层中的长期预后价值，并将其与肿瘤分级（2010 年世界卫生组织分类）进行比较。
我们进行了一项前瞻性队列研究，评估了 F-FDG PET 成像的预后价值，并将其与组织学分级进行了比较。共纳入了来自胃肠道胰腺来源的所有分级和组织学证实的 NENs 患者 166 例。主要终点是总生存期（OS）。无进展生存期（PFS）为次要终点。此外，还分析了与肽受体放射性核素治疗（PRRT）相关的 OS 作为探索性终点。中位随访时间为 9.8 年。
对整个队列的分析表明，阳性 F-FDG PET 扫描与阴性 F-FDG PET 扫描相比，OS 更短（风险比：3.8；95%CI：2.4-5.9；<0.001）。在 G1 和 G2 患者（=140）中，阳性 F-FDG PET 扫描是死亡高风险的唯一标志（风险比：3.6；95%CI，2.2-5.9；<0.001）。多变量分析显示，F-FDG PET、G3 肿瘤、≥2 个肝转移灶和≥2 次既往治疗是 OS 的独立预后因素，F-FDG PET、G3 肿瘤和≥3 个肝转移灶是 PFS 的独立预后因素。对于接受 PRRT 的患者，F-FDG 阴性病例的生存时间明显长于 F-FDG 阳性病例，而肿瘤分级则没有差异。接受 PRRT 的 F-FDG 阳性患者的中位生存时间明显长于未接受 PRRT 的患者（4.4 比 1.4 年，=0.001），而 F-FDG 阴性患者则没有差异。F-FDG PET 对所有 NEN 分级的风险分层均有用，优于组织学分级。F-FDG PET 可将 G1 和 G2 肿瘤分为低风险和高风险组。在选择治疗方案和 NEN 患者的风险分层时，应考虑 F-FDG PET 状态。
