Background: Treatment of metastatic neuroendocrine tumors (NET) with177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) results in favorable response only in a subset of patients. We investigated the prognostic value of quantitative pre-treatment semi-automatic68Ga-DOTATATE PET/CT analysis in NET patients treated with PRRT. Methods: The medical records of 94 NET patients who received at least one cycle of PRRT at a single institution were retrospectively reviewed. On each pre-treatment68Ga-DOTATATE PET/CT, the total tumor volume (TTV), maximum tumor standardized uptake value for the patient (SUVmax), and average uptake in the lesion with the lowest radiotracer uptake (SUVmin) were determined with a semi-automatic tumor delineation method. Progression-free survival (PFS) and overall survival (OS) among the patients were compared based on optimal cutoff values for the imaging parameters. Results: On Kaplan–Meier analysis and univariate Cox regression, significantly shorter PFS was observed in patients with lower SUVmax, lower SUVmin, and higher TTV. On multivariate Cox regression, lower SUVmin and higher TTV remained predictive of shorter PFS. Only higher TTV was found to be predictive of shorter OS on Kaplan–Meier and Cox regression analyses. In a post hoc Kaplan–Meier analysis, patients with at least one high-risk feature (low SUVmin or high TTV) showed shorter PFS and OS, which may be the most convenient parameter to measure in clinical practice. Conclusions: The tumor volume and lowest lesion uptake on68Ga-DOTATATE PET/CT can predict disease progression following PRRT in NET patients, with the former also predictive of overall survival. NET patients at risk for poor outcomes following PRRT can be identified with semi-automated quantitative analysis of68Ga-DOTATATE PET/CT.
背景：使用¹⁷⁷Lu-DOTATATE肽受体放射性核素治疗（PRRT）治疗转移性神经内分泌肿瘤（NET）仅在一部分患者中产生良好疗效。本研究探讨了定量治疗前半自动⁶⁸Ga-DOTATATE PET/CT分析对接受PRRT治疗的NET患者的预后价值。方法：回顾性分析了94例在同一机构接受至少一个周期PRRT的NET患者的医疗记录。采用半自动肿瘤勾画方法，对每位患者治疗前的⁶⁸Ga-DOTATATE PET/CT图像进行分析，确定总肿瘤体积（TTV）、患者最大肿瘤标准化摄取值（SUVmax）以及放射性示踪剂摄取最低病灶的平均摄取值（SUVmin）。根据影像学参数的最佳截断值，比较患者的无进展生存期（PFS）和总生存期（OS）。结果：Kaplan-Meier分析和单变量Cox回归显示，SUVmax较低、SUVmin较低以及TTV较高的患者PFS显著缩短。多变量Cox回归分析表明，较低的SUVmin和较高的TTV仍是PFS缩短的预测因素。Kaplan-Meier和Cox回归分析发现，仅较高的TTV是OS缩短的预测因素。在事后Kaplan-Meier分析中，具有至少一个高风险特征（低SUVmin或高TTV）的患者表现出更短的PFS和OS，这可能是临床实践中最便于测量的参数。结论：⁶⁸Ga-DOTATATE PET/CT上的肿瘤体积和最低病灶摄取可以预测NET患者PRRT后的疾病进展，其中前者还能预测总生存期。通过对⁶⁸Ga-DOTATATE PET/CT进行半自动定量分析，可以识别出PRRT后预后不良风险的NET患者。
肿瘤(癌症)患者之家