Rationale and Objectives
High-grade gastroenteropancreatic neuroendocrine neoplasms (G3 GEP-NENs) are pathologically
classified into well differentiated neuroendocrine tumors (G3 NETs) and poorly differentiated
neuroendocrine carcinomas (G3 NECs). Using a novel parameter, we examined the prognostic
value of 18F-FDG and 68Ga-DOTATATE PET/CT quantification in comparison to pathologic assessment in G3 GEP-NENs.
Materials and Methods
A total of 31 patients with G3 GEP-NENs were reviewed. For each patient, the SUVmax
on 18F-FDG and 68Ga-DOTATATE PET/CT were used to calculate the FDG-DOTATATE-Z (FDZ) score: a continuous
parameter that increases with 68Ga-DOTATATE uptake and decreases with 18F-FDG uptake. The variation in the FDZ score with respect to pathologic variables
was examined. Kaplan-Meier and Cox regression analyses were performed to evaluate
the effect of FDZ score on overall survival. An external cohort of 21 patients was
used for validation.
Results
The FDZ score was significantly higher in G3 NETs compared to G3 NECs (p<0.001), and was inversely correlated with Ki67 index (R2=0.33, p<0.001). Patients in the FDZ>0.05 group showed significantly longer survival compared
to those in the FDZ≤0.05 group, with median of 34.9 vs. 12.0 months (p<0.001). On univariate regression, FDZ>0.05 (p=0.005), well differentiated disease (p=0.044), and lower Ki67 index (p=0.042) were predictors of survival. On multivariate regression, only FDZ>0.05 could
independently predict longer survival with HR=0.16 (p=0.018), which was reproduced in the external validation cohort.
Conclusion
Combined quantification of 18F-FDG and 68Ga-DOTATATE PET/CT into a novel parameter, the FDZ score, reflects the pathologic
characteristics of G3 GEP-NENs and is a prognostic indicator of overall survival independent
of differentiation.
Key Words
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Article Info
Publication History
Published online: November 23, 2021
Accepted:
October 5,
2021
Received in revised form:
October 4,
2021
Received:
June 10,
2021
Identification
Copyright
© 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
