Prognostic value of whole-body PET volumetric parameters extracted from 68Ga-DOTATOC-PET/CT in well-differentiated neuroendocrine tumors

Philippe Thuillier*, Virginia Liberini, Serena Grimaldi, Osvaldo Rampado, Elena Gallio, Bruno De Santi, Emanuela Arvat, Alessandro Piovesan, Roberto Filippi, Ronan Abgral, Filippo Molinari, Désirée Deandreis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Scopus)
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Abstract

Aim: To evaluate the prognostic value of somatostatin receptor tumor burden (SRTB) at 68Ga-DOTATOC positron emission tomography/computed tomography (PET/CT) in patients with well-differentiated neuroendocrine tumors (WD-NETs). Methods: We retrospectively analyzed 68Ga-DOTATOC-PET/CT of 84 patients with histologically confirmed WD-NETs (51 G1, 30 G2 and 3 G3). For each PET/CT, all DOTATOC-avid lesions were independently segmented by 2 operators using a customized threshold based on the healthy liver maximum standardized uptake value (SUVmax) using LIFEx 5.1. Somatostatin receptor expressing tumor volume (SRETV) and total lesion somatostatin receptor expression (TLSRE=SRETV*SUVmean) were extracted for each lesion and then whole-body SRETV and TLSRE (SRETVwb and TLSREwb) were defined as the sum of SRETV and TLSRE of all segmented lesions in each patient, respectively. Time to progression (TTP) was defined as the combination of disease-free-survival in patients undergoing curative surgery (n=10) and progression-free survival for patients with unresectable/metastatic disease (n=74). TTP and overall survival (OS) were calculated by Kaplan-Meier analysis, log-rank test, and Cox’s proportional hazard model. Results: After a median follow-up period of 15.5 months disease progression was confirmed in 35 patients (41.7%) and 14 patients died. Higher SRETVwb (>39.1ml) and TLSREwb (>306.8g) were significantly correlated with shorter median TTP (TTP=12months vs not reached; p<0.001). In multivariate analysis, SRETVwb (p=0.005) was the only independent predictor of TTP regardless of histopathologic grade and TNM staging. Conclusion: According to our results, SRETVwb and TLSREwb extracted from 68Ga-DOTATOC-PET/CT could predict TTP/OS and might have an important clinical utility in the management of in patients with WD-NETs.

Original languageEnglish
Pages (from-to)1014-1020
JournalThe Journal of nuclear medicine
Volume63
Issue number7
Early online date30 Jun 2022
DOIs
Publication statusPublished - 1 Jul 2022
Externally publishedYes

Keywords

  • Ga-DOTATOC-PET/CT
  • Neuroendocrine tumors
  • prognosis
  • somatostatin receptor expressing tumor volume
  • total lesion somatostatin receptor expression
  • Tumor burden

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