F-DOPA PET 检测到转移性中肠神经内分泌肿瘤患者的骨转移对预后的影响。
Prognostic impact of bone metastases detected by F-DOPA PET in patients with metastatic midgut neuroendocrine tumors.
机构信息
Department of Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France.
Université de Paris, Paris, France.
出版信息
Eur Radiol. 2021 Jun;31(6):4166-4174. doi: 10.1007/s00330-020-07554-6. Epub 2020 Nov 27.
OBJECTIVES
Bone metastases (BM) may influence negatively the prognosis of midgut neuroendocrine tumors (NET). The diagnostic sensitivity of F-DOPA PET for midgut NET and associated metastases is high. This study aimed to assess the prognostic impact of BM detected by F-DOPA PET in metastatic midgut NET.
METHODS
All patients with a metastatic midgut NET, who underwent a F-DOPA PET between June 2011 and June 2018, were included. BM were defined following imaging criteria and were classified as poly-BM or oligo-BM, according to their number (< 5 or ≥ 5, respectively). The variables associated with the presence of BM were evaluated by logistic regression. The factors associated with overall survival were explored by Cox regression models.
RESULTS
Among 155 patients included, 46 had BM (29.7%). A carcinoid syndrome (OR 2.96, p = 0.009) and ≥ 3 extra-skeletal metastatic organs (OR 4.99, p = 0.002) were independently associated with the presence of BM. BM were mainly osteoblastic (78%), rarely symptomatic (8.9%), and had a short-term therapeutic impact for 3 patients (6.5%). The presence of BM (HR 2.67, p = 0.034), older age (HR 1.07, p = 0.016), and higher Ki67 (HR 1.09, p = 0.025) were independent prognostic factors. Unlike poly-BM (HR 1.92, p = 0.007), oligo-BM was not a poor prognosis factor (HR 0.77, p = 0.699) compared to the group without BM.
CONCLUSION
F-DOPA PET frequently detects BM in patients with metastatic midgut NET. BM have a negative prognostic impact, especially poly-BM. Conversely, oligo-BM do not influence the prognosis and may not impact therapeutic decisions.
KEY POINTS
• F-DOPA PET detected bone metastases in 46 (29.7%) of 155 patients with metastatic midgut neuroendocrine tumors. • Bone metastases have a negative prognostic impact in metastatic midgut neuroendocrine tumors. • Bone oligo-metastases (< 5) do not influence the prognosis and may not impact therapeutic decisions.
目的
骨转移（BM）可能对中肠神经内分泌肿瘤（NET）的预后产生负面影响。F-DOPA PET 对中肠 NET 和相关转移的诊断灵敏度很高。本研究旨在评估 F-DOPA PET 检测到的 BM 对转移性中肠 NET 的预后影响。
方法
纳入 2011 年 6 月至 2018 年 6 月间进行 F-DOPA PET 的转移性中肠 NET 患者。根据影像学标准定义 BM，并根据其数量（< 5 或 ≥ 5）将其分类为多 BM 或寡 BM。采用逻辑回归评估与 BM 存在相关的变量。采用 Cox 回归模型探讨与总生存相关的因素。
结果
在纳入的 155 例患者中，46 例有 BM（29.7%）。类癌综合征（OR 2.96，p = 0.009）和≥3 个骨骼外转移性器官（OR 4.99，p = 0.002）与 BM 的存在独立相关。BM 主要为成骨（78%），很少有症状（8.9%），3 例（6.5%）有短期治疗效果。BM 的存在（HR 2.67，p = 0.034）、年龄较大（HR 1.07，p = 0.016）和 Ki67 较高（HR 1.09，p = 0.025）是独立的预后因素。与多 BM（HR 1.92，p = 0.007）不同，寡 BM 与无 BM 组相比并非不良预后因素（HR 0.77，p = 0.699）。
结论
F-DOPA PET 常可在转移性中肠 NET 患者中检测到 BM。BM 具有负性预后影响，尤其是多 BM。相反，寡 BM 不会影响预后，也可能不会影响治疗决策。
重点
• F-DOPA PET 在 155 例转移性中肠神经内分泌肿瘤患者中检测到 46 例（29.7%）骨转移。
• 骨转移对转移性中肠神经内分泌肿瘤有负性预后影响。
• 骨寡转移（< 5）不影响预后，也可能不影响治疗决策。
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