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[F]FDG PET/CT and [Ga]Ga-DOTATATE PET/CT are both used to predict tumor biology in neuroendocrine neoplasms. Although the presence of discordant ([F]FDG-avid/non-[Ga]Ga-DOTATATE-avid) disease predicts poor prognosis, the significance of the volume of such discordant disease remains undetermined. The aim of this study is to investigate discordant tumor volume as a potential biomarker in patients with advanced gastroenteropancreatic neuroendocrine neoplasms (GEPNENs). A multicenter retrospective study in patients with advanced GEPNENs and paired [F]FDG and [Ga]Ga-DOTATATE PET/CT no more than 85 d apart was conducted. Patients with discordant disease were identified by the NETPET score, and discordant lesions were contoured with a flat [F]FDG SUV cutoff of 4. The primary variable of interest was the total discordant volume (TDV), which was the sum of the volumes of discordant lesions. Patients were dichotomized into high- and low-TDV cohorts by the median value. The primary endpoint was overall survival. In total, 44 patients were included (50% men; median age, 60 y), with primary cancers in the pancreas (45%), small bowel (23%), colon (20%), and other (12%). Of the patients, 5% had grade 1 disease, 48% had grade 2 disease, and 48% had grade 3 disease (24% well differentiated, 67% poorly differentiated, 10% unknown within the grade 3 cohort). The overall median survival was 14.1 mo. Overall survival was longer in the low-TDV cohort than in the high-TDV cohort (median volume, 43.7 cm; survival time, 23.8 mo vs. 9.4 mo; hazard ratio, 0.466 [95% CI, 0.229-0.948]; = 0.0221). Patients with no more than 2 discordant intrahepatic lesions survived longer than those with 2 or more lesions (31.8 mo vs. 10.2 mo, respectively; hazard ratio, 0.389 [95% CI, 0.194-0.779]; = 0.0049). TDV is a potential prognostic biomarker in GEPNENs and should be investigated in future neuroendocrine neoplasm trials.

[F]FDG PET/CT 和 [Ga]Ga-DOTATATE PET/CT 均用于预测神经内分泌肿瘤的肿瘤生物学。尽管存在不一致的疾病（[F]FDG 阳性/非-[Ga]Ga-DOTATATE 阳性）预测预后不良，但这种不一致疾病的体积的意义仍未确定。本研究旨在探讨晚期胃肠胰腺神经内分泌肿瘤（GEPNENs）患者中不一致肿瘤体积作为潜在的生物标志物。

一项多中心回顾性研究纳入了晚期 GEPNENs 患者，这些患者的 [F]FDG 和 [Ga]Ga-DOTATATE PET/CT 检查结果不超过 85 天。通过 NETPET 评分确定存在不一致疾病的患者，并使用 4 的平 [F]FDG SUV 截断值对不一致病变进行轮廓勾画。主要观察变量是总不一致体积（TDV），即不一致病变体积的总和。根据中位数将患者分为高 TDV 组和低 TDV 组。主要终点是总生存。

共纳入 44 例患者（50%为男性；中位年龄 60 岁），原发肿瘤位于胰腺（45%）、小肠（23%）、结肠（20%）和其他部位（12%）。其中，5%的患者为 1 级疾病，48%为 2 级疾病，48%为 3 级疾病（24%为高分化，67%为低分化，10%在 3 级组中未知）。总体中位生存时间为 14.1 个月。低 TDV 组的总生存时间长于高 TDV 组（中位体积为 43.7cm；生存时间分别为 23.8 个月和 9.4 个月；风险比为 0.466[95%CI，0.229-0.948]；=0.0221）。无 2 个以上肝内不一致病灶的患者比有 2 个或更多病灶的患者生存时间更长（分别为 31.8 个月和 10.2 个月；风险比为 0.389[95%CI，0.194-0.779]；=0.0049）。

TDV 是 GEPNENs 的一种潜在预后生物标志物，应在未来的神经内分泌肿瘤试验中进行研究。