Volumetric parameters from [¹⁸F]FDG PET/CTpredicts survival in patients with high‐grade gastroenteropancreatic neuroendocrine neoplasms

Abstract

A positive fluorine-18 labelled 2-deoxy-2-fluoroglucose ([ 18 F]FDG) positron emission tomography/computed tomography (PET/CT) has been associated with more aggressive disease and less differentiated neuroendocrine neoplasms (NEN). Although a high maximum standardized uptake value (SUV max ) predicts poor outcome in NEN, volumetric parameters from [ 18 F]FDG PET have not been evaluated for prognostication in a pure high-grade gastroenteropancreatic (GEP) NEN cohort. In this retrospective observational study, we evaluated the volumetric PET parameters total metabolic tumour volume (tMTV) and total total lesion glycolysis (tTLG) for independent prognostication of overall survival (OS). High-grade GEP NEN patients with [ 18 F]FDG PET/CT examination and biopsy within 90 days were included. Total MTV and tTLG were calculated using an adaptive thresholding software. Patients were dichotomised into low and high metabolic groups based on median tMTV and tTLG.OS was compared using Kaplan-Meier estimator and log-rank test. Uni and multivariable Cox regression was used to estimate effect sizes and adjust for tumour differentiation and SUV max . Sixty-six patients (median age 64 years) were included with 14 NET G3 and 52 NEC cases after histological re-evaluation. Median tMTV was 208 cm 3 and median tTLG 1899 g. Median OS in the low versus high tMTV-group was 21.2 versus 5.7 months (HR 2.53, p = 0.0007) and 22.8 versus 5.7 months (HR 2.42, p = 0.0012) in the tTLG-group. Adjusted for tumour differentiation and SUV max , tMTV and tTLG still predicted for poor OS, and both tMTV and tTLG were stronger prognostic parameters than SUV max . Both regression models showed a strong association between volumetric parameters and OS for both neuroendocrine tumours (NET) G3 and neuroendocrine carcinomas (NEC). OS for the tTLG low metabolic NEC was much higher than for the tTLG high metabolic NET G3 (18.3 vs. 5.7 months).High-grade GEP NEN patients with high tMTV or tTLG had a worse OS regardless of

Prognostic value of pretreatment 18F-FDG PET/CT metabolic parameters in esophageal high-grade neuroendocrine carcinoma: A bicenter retrospective study

“…In a recent study, Stokmo et al. evaluated 66 patients with high-grade GEP NEN, and found MTV and TLG were also stronger prognostic parameters than SUVmax ( 21 ). Several studies also reported the prognostic value of SUVmax in NEN with higher SUVmax predicting poor outcome ( 22 – 24 ).…”

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for digestive neuroendocrine carcinoma

“…A GI‐NEC score to prognosticate overall survival included five variables: presence of liver metastases, ALP, LDH, PS and Ki‐67, and identified two distinct patient cohorts 37 . 18 F‐FDG‐PET avid disease correlates with worse prognosis in NEC patients 38 . Emerging data show a possible benefit of analyzing gene mutations, which may possibly guide treatment 7,8 .…”

“…37 18 F-FDG-PET avid disease correlates with worse prognosis in NEC patients. 38 Emerging data show a possible benefit of analyzing gene mutations, which may possibly guide treatment. 7,8 In contrast to colorectal adenocarcinoma, BRAF V600E mutations do not seem to be prognostic for colorectal NEC and few prognostic molecular markers have been found for digestive NEC.…”

Towards Understanding the Survival of Patients with High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms: An Investigation of Ensemble Feature Selection in the Prediction of Overall Survival

“…Patient cohort Patients were identified from a single institutional cohort at Oslo University Hospital, also included in two multi-institutional Nordic NEC registries organized by the Nordic Neuroendocrine Tumor Group, previously described by [8]. In short, this cohort consisted of 192 patients included between January 2000 and July 2018, with GEP NEC classified according to the WHO 2010-classification [28].…”

“…The prognosis for patients with advanced GEP NEC is poor, with a median survival of less than 12 months [5,6], whilst the prognosis for locoregional GEP NEC is higher; 20.7 months [7]. Numerous recently published studies [5,[8][9][10][11][12][13][14] have shown the prognostic importance of several parameters on overall survival (OS) such as age, performance status (PS), primary tumor site, tumor differentiation, TNM-stage, serum lactate dehydrogenase (LDH), serum platelet levels, proliferation marker Ki-67, maximum standardized uptake value (SUV max ), total metabolic tumor volume (tMTV) and total total lesion glycolysis (tTLG). Establishing more robust prognostic parameters and validating established parameters is essential to provide optimal care for this patient group.…”