Volumetric parameters from [18 F]FDG PET/CT predicts survival in patients with high-grade gastroenteropancreatic neuroendocrine neoplasms

Henning Langen Stokmo; Mahmoud Aly; Inger Marie Bowitz Lothe; Austin J Borja; Siavash Mehdizadeh Seraj; Rina Ghorpade; Xuan Miao; Geir Olav Hjortland; Eirik Malinen; Halfdan Sorbye; Thomas J Werner; Abass Alavi; Mona-Elisabeth Revheim

doi:10.1111/jne.13170

Volumetric parameters from [¹⁸ F]FDG PET/CT predicts survival in patients with high-grade gastroenteropancreatic neuroendocrine neoplasms

J Neuroendocrinol. 2022 Jul;34(7):e13170. doi: 10.1111/jne.13170. Epub 2022 Jun 21.

Authors

Henning Langen Stokmo^{1

2}, Mahmoud Aly^{3

4}, Inger Marie Bowitz Lothe⁵, Austin J Borja^{3

6}, Siavash Mehdizadeh Seraj³, Rina Ghorpade³, Xuan Miao³, Geir Olav Hjortland⁷, Eirik Malinen^{8

9}, Halfdan Sorbye^{10

11}, Thomas J Werner³, Abass Alavi³, Mona-Elisabeth Revheim^{1

2

3}

Affiliations

¹ Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Radiology, Asyut University Hospital, Asyut, Egypt.
⁵ Department of Pathology, Oslo University Hospital, Oslo, Norway.
⁶ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁷ Department of Oncology, Oslo University Hospital, Oslo, Norway.
⁸ Department of Medical Physics, Oslo University Hospital, Oslo, Norway.
⁹ Department of Physics, University of Oslo, Oslo, Norway.
¹⁰ Department of Oncology, Haukeland University Hospital, Bergen, Norway.
¹¹ Department of Clinical Science, University of Bergen, Bergen, Norway.

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 cm³ 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 tumour differentiation (NET G3 or NEC). Volumetric PET parameters were stronger prognostic parameters than SUV_max .

Keywords: [18F]FDG PET/CT; high-grade gastroenteropancreatic neuroendocrine neoplasia; overall survival; prognosis; volumetric parameters.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Fluorodeoxyglucose F18* / metabolism
Humans
Middle Aged
Neuroendocrine Tumors* / diagnostic imaging
Positron Emission Tomography Computed Tomography / methods
Prognosis
Tumor Burden

Substances

Fluorodeoxyglucose F18