联合 F-FDG 和 Ga-DOTATATE PET/CT 对高级胃肠胰神经内分泌肿瘤进行预后评估。

Combined Quantification of F-FDG and Ga-DOTATATE PET/CT for Prognosis in High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms.

机构信息

Department of Radiology (H.L., S.E.M., A.R.P., D.A.P.), University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104; Department of Radiology (R.N., C.M.A.), Stanford University School of Medicine, Stanford, California; Department of Medicine (J.R.E.), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

出版信息

Acad Radiol. 2022 Sep;29(9):1308-1316. doi: 10.1016/j.acra.2021.10.004. Epub 2021 Nov 24.

DOI:10.1016/j.acra.2021.10.004

PMID:34836776

Abstract

RATIONALE AND OBJECTIVES

High-grade gastroenteropancreatic neuroendocrine neoplasms (G3 GEP-NENs) are pathologically classified into well differentiated neuroendocrine tumors (G3 NETs) and poorly differentiated neuroendocrine carcinomas (G3 NECs). Using a novel parameter, we examined the prognostic value of F-FDG and Ga-DOTATATE PET/CT quantification in comparison to pathologic assessment in G3 GEP-NENs.

MATERIALS AND METHODS

A total of 31 patients with G3 GEP-NENs were reviewed. For each patient, the SUVmax on F-FDG and Ga-DOTATATE PET/CT were used to calculate the FDG-DOTATATE-Z (FDZ) score: a continuous parameter that increases with Ga-DOTATATE uptake and decreases with F-FDG uptake. The variation in the FDZ score with respect to pathologic variables was examined. Kaplan-Meier and Cox regression analyses were performed to evaluate the effect of FDZ score on overall survival. An external cohort of 21 patients was used for validation.

RESULTS

The FDZ score was significantly higher in G3 NETs compared to G3 NECs (p<0.001), and was inversely correlated with Ki67 index (R=0.33, p<0.001). Patients in the FDZ>0.05 group showed significantly longer survival compared to those in the FDZ≤0.05 group, with median of 34.9 vs. 12.0 months (p<0.001). On univariate regression, FDZ>0.05 (p=0.005), well differentiated disease (p=0.044), and lower Ki67 index (p=0.042) were predictors of survival. On multivariate regression, only FDZ>0.05 could independently predict longer survival with HR=0.16 (p=0.018), which was reproduced in the external validation cohort.

CONCLUSION

Combined quantification of F-FDG and Ga-DOTATATE PET/CT into a novel parameter, the FDZ score, reflects the pathologic characteristics of G3 GEP-NENs and is a prognostic indicator of overall survival independent of differentiation.

摘要

背景与目的

高级胃肠胰神经内分泌肿瘤（G3 GEP-NENs）在病理上分为高分化神经内分泌肿瘤（G3 NETs）和低分化神经内分泌癌（G3 NECs）。我们使用一种新参数，通过比较病理评估，研究了 F-FDG 和 Ga-DOTATATE PET/CT 定量在 G3 GEP-NENs 中的预后价值。

材料与方法

共回顾了 31 例 G3 GEP-NEN 患者。对每位患者，F-FDG 和 Ga-DOTATATE PET/CT 的 SUVmax 用于计算 FDG-DOTATATE-Z（FDZ）评分：一个随 Ga-DOTATATE 摄取增加和 F-FDG 摄取减少而增加的连续参数。研究了 FDZ 评分与病理变量的变化关系。进行 Kaplan-Meier 和 Cox 回归分析，以评估 FDZ 评分对总生存期的影响。使用 21 例患者的外部队列进行验证。

结果

G3 NETs 的 FDZ 评分明显高于 G3 NECs（p<0.001），并与 Ki67 指数呈负相关（R=0.33，p<0.001）。FDZ>0.05 组的患者生存时间明显长于 FDZ≤0.05 组，中位生存期分别为 34.9 个月和 12.0 个月（p<0.001）。单因素回归分析显示，FDZ>0.05（p=0.005）、分化良好的疾病（p=0.044）和较低的 Ki67 指数（p=0.042）是生存的预测因素。多因素回归分析显示，只有 FDZ>0.05 才能独立预测更长的生存期，HR=0.16（p=0.018），这在外部验证队列中得到了重现。