Herr Felix L, Dascalescu Christian, Fabritius Matthias P, Sheikh Gabriel T, Zacherl Mathias J, Wenter Vera, Unterrainer Lena M, Brendel Matthias, Holzgreve Adrien, Auernhammer Christoph J, Spitzweg Christine, Burkard Tanja, Ricke Jens, Heimer Maurice M, Cyran Clemens C
Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany;
Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.
J Nucl Med. 2025 May 1;66(5):726-731. doi: 10.2967/jnumed.124.268621.
Despite well-documented limitations, current guidelines recommend the use of size-based RECIST 1.1 for response assessment of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) under radiopharmaceutical therapy (RPT). We hypothesize that functional criteria are superior to RECIST 1.1 for response assessment and progression-free survival (PFS) prediction, and molecular scores can be used in prognosticating PFS. This single-center, retrospective study included 178 patients with GEP-NETs (G1 and G2) who were treated with at least 2 consecutive cycles of RPT with [Lu]Lu-DOTATATE and who underwent somatostatin receptor PET/CT at baseline and after 2 cycles of RPT (follow-up). PFS was defined as the time between baseline and clinical progression, as reported by a GEP-NET multidisciplinary tumor board (MDT) assessment or reported death. The differences in categorization and PFS between RECIST 1.1, Choi (functional criteria), and the MDT were evaluated, and 3-y PFS with MDT defined PFS as the reference. The predictive values of the different scores in somatostatin receptor standardized reporting and data system and Krenning (molecular scores) for PFS were analyzed. Choi criteria classified a higher number of patients as having progressive disease and partial response and a lower number of patients as having stable disease compared with RECIST 1.1 ( < 0.01). The PFS of patients with progressive disease according to RECIST 1.1 and Choi criteria was shorter than that of patients with stable disease and partial response ( < 0.05). Choi criteria showed a nonsignificantly higher concordance with the MDT than with RECIST 1.1. There was a shift in category from a Krenning score of 4 to a score of 3 between baseline and follow-up ( < 0.01). At baseline, a Krenning score of 3 was associated with a shorter median PFS compared with a score of 4 ( < 0.05). In addition to RECIST 1.1, further PET- and CT-based imaging criteria have the potential to assess response and predict PFS in patients with GEP-NETs undergoing RPT. Our data support the assumption to use Choi criteria for prediction of PFS and agreement in response assessment. At baseline, the Krenning score can be used to predict therapy response after 2 cycles of RPT.
尽管有充分记录的局限性，但当前指南仍推荐使用基于大小的RECIST 1.1对接受放射性药物治疗（RPT）的胃肠胰神经内分泌肿瘤（GEP-NETs）进行疗效评估。我们假设，在疗效评估和无进展生存期（PFS）预测方面，功能标准优于RECIST 1.1，并且分子评分可用于预测PFS。这项单中心回顾性研究纳入了178例GEP-NETs（G1和G2）患者，这些患者接受了至少2个连续周期的[Lu]Lu- DOTATATE RPT治疗，并在基线期和2个周期的RPT治疗后（随访）接受了生长抑素受体PET/CT检查。PFS定义为基线期至临床进展的时间，由GEP-NET多学科肿瘤委员会（MDT）评估报告或报告的死亡情况确定。评估了RECIST 1.1、Choi（功能标准）和MDT在分类和PFS方面的差异，并以MDT定义的PFS作为3年PFS的参考。分析了生长抑素受体标准化报告和数据系统以及Krenning（分子评分）中不同评分对PFS的预测价值。与RECIST 1.1相比，Choi标准将更多患者分类为疾病进展和部分缓解，而将更少患者分类为疾病稳定（<0.01）。根据RECIST 1.1和Choi标准，疾病进展患者的PFS短于疾病稳定和部分缓解患者（<0.05）。Choi标准与MDT的一致性略高于与RECIST 1.1的一致性，但差异无统计学意义。在基线期和随访之间，Krenning评分从4分降至3分（<0.01）。在基线期，Krenning评分为3分的患者中位PFS短于评分为4分的患者（<0.05）。除了RECIST 1.1之外，基于PET和CT的进一步成像标准有可能评估接受RPT的GEP-NETs患者的疗效并预测PFS。我们的数据支持使用Choi标准预测PFS并在疗效评估中达成一致的假设。在基线期，Krenning评分可用于预测2个周期RPT后的治疗反应。
