18F-FDG PET is Superior to WHO Grading as a Prognostic Tool in Neuroendocrine Neoplasms and Useful in Guiding PRRT: A Prospective 10-Year Follow-up Study
18F-FDG PET is Superior to WHO Grading as a Prognostic Tool in Neuroendocrine Neoplasms and Useful in Guiding PRRT: A Prospective 10-Year Follow-up Study
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DOI：
10.2967/jnumed.120.244798
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发表时间：
2021-06-01
影响因子：
9.3
通讯作者：
Kjaer, Andreas
中科院分区：
文献类型：
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作者：
Binderup, Tina;Knigge, Ulrich;Kjaer, Andreas
神经内分泌肿瘤（NEN）患者的准确分级对于风险分层和最佳治疗选择至关重要。目前，分级是基于组织学评估的肿瘤增殖程度。本研究的目的是评估F-18-FDG PET成像对NEN风险分层的长期预后价值，并将其与肿瘤分级（世界卫生组织2010年分类）进行比较。方法：我们进行了一项前瞻性队列研究，评估F-18-FDG PET成像的预后价值，并将其与组织学分级进行比较。入组了166例所有级别的患者，经组织学证实为胃肠胰腺源性NEN。主要终点为总生存期（OS）。无进展生存期（PFS）是次要终点。此外，将与肽受体放射性核素治疗（PRRT）相关的OS作为探索性终点进行分析。中位随访时间为9.8年。结果如下：对整个队列的分析显示，与F-18-FDG PET扫描阴性相比，F-18-FDG PET扫描阳性与更短的OS相关（风险比：3.8; 95% CI：2.4-5.9; P < 0.001）。在G1和G2患者（n = 140）中，F-18-FDG PET扫描阳性是死亡高风险的唯一标识符（风险比：3.6; 95%CI，2.2-5.9; P < 0.001）。在多变量分析中，F-18-FDG PET、G3肿瘤、≥ 2个肝转移和≥ 2个既往治疗是OS的独立预后因素，F-18-FDG PET、G3肿瘤和≥ 3个肝转移是PFS的独立预后因素。对于接受PRRT的患者，F-18-FDG阴性病例的生存期明显长于F-18-FDG阳性病例，而肿瘤分级无差异。接受PRRT的F-18-FDG阳性患者的中位生存期显著长于未接受PRRT的患者（4.4 vs. 1.4 y，P = 0.001），而F-18-FDG阴性患者无差异。结论：F-18-FDG PET可用于所有NEN分级的危险分层，且上级优于组织学分级。F-18-FDG PET可以将G1和G2肿瘤区分为低风险和高风险组。在选择治疗和NEN患者的风险分层时，应考虑F-18-FDG PET状态。
Accurate grading of patients with neuroendocrine neoplasms (NENs) is essential for risk stratification and optimal choice of therapy. Currently, grading is based on histologically assessed degree of tumor proliferation. The aim of the present study was to assess the long-term prognostic value of F-18-FDG PET imaging for risk stratification of NENs and compare it with tumor grading (World Health Organization 2010 classification). Methods: We conducted a prospective cohort study evaluating the prognostic value of F-18-FDG PET imaging and compared it with histologic grading. Enrolled were 166 patients of all grades and with histologically confirmed NENs of gastroenteropancreatic origin. The primary endpoint was overall survival (OS). Progression-free survival (PFS) was a secondary endpoint. In addition, OS in relation to peptide receptor radionuclide therapy (PRRT) was analyzed as an exploratory endpoint. The median follow-up time was 9.8 y. Results: Analysis of the whole cohort revealed that a positive F-18-FDG PET scan was associated with a shorter OS than a negative F-18-FDG PET scan (hazard ratio: 3.8; 95% CI: 2.4-5.9; P < 0.001). In G1 and G2 patients (n = 140), a positive F-18-FDG PET scan was the only identifier of high risk for death (hazard ratio: 3.6; 95% CI, 2.2-5.9; P < 0.001). In multivariate analysis, F-18-FDG PET, G3 tumor, >= 2 liver metastases, and >= 2 prior therapies were independent prognostic factors for OS, and F-18-FDG PET, G3 tumor, and >= 3 liver metastases were independent prognostic factors for PFS. For patients receiving PRRT, F-18-FDG-negative cases had a significantly longer survival than F-18- FDG-positive cases, whereas no difference was identified for tumor grading. F-18-FDG-positive patients receiving PRRT had a significantly longer median survival than patients not receiving PRRT (4.4 vs. 1.4 y, P = 0.001), whereas no difference was seen for F-18-FDG-negative patients. Conclusion: F-18-FDG PET is useful for risk stratification of all NEN grades and is superior to histologic grading. F-18-FDG PET could differentiate G1 and G2 tumors into low- and high-risk groups. In the selection of therapy and for risk stratification of NEN patients, F-18-FDG PET status should be considered.