Value of 111In-Pentetreotide scintigraphy and 18F-FDG PET for clinical prognosis of patients with neuroendocrine neoplasms

Abstract

Despite the existence of biological markers of aggressiveness, the clinical course of gastro-entero-pancreatic (GEP) neuroendocrine neoplasms (NEN) remains difficult to predict. Discrepancies between imaging data generated with 111In-pentetreotide scintigraphy and 18F-FDG-PET could reflect the degree of cellular de-differentiation. NEN patients with both types of studies were identified retrospectively from the SwissNET database, which is collecting information on Swiss NEN patients since 2008. Progression free survival (PFS) and overall survival (OS) were assessed depending on functional imaging results. Correlation between histological grading (according to the WHO 2010 classification) and functional imaging status was also assessed. We identified 31 patients with both imaging studies, either on the primary tumor site (21/31) or for metastases (21/31), with 12/31 on both sites. Mean follow-up was 36 months (95% CI 27–45). 21 patients had a metastatic disease at diagnosis and 11 died at follow-up. 7/31 (22%) were NET G1, 16/31 (52%) were NET G2 and 8/31 (26%) were NEC G3. Only 18F-FDG PET status almost reached statistical significance (P=0.054) with histological grading. Progression free-survival was significantly poorer in the 18F-FDG positive group (n=21), with a median time for progression of 8 months, compared to 51 months in the negative group (n=10) with a HR of 3.2 (97.5% CI 1.1–9.5, P=0.04). Overall survival tended to be worse with a positive PET and a negative 111In-pentetreotide scintigraphy status with a HR 1.63 (97.5%CI 0.11–21, P=0.08). 111In-pentetreotide scintigraphy status was not found to be predictive of survival nor progression. ConclusionThese data demonstrate the poorer prognostic value of a positive 18F-FDG-PET imaging in this cohort of patients.