Prognostic impact of bone metastases detected by 18 F-DOPA PET in patients with metastatic midgut neuroendocrine tumors
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MOLECULAR IMAGING
Prognostic impact of bone metastases detected by 18F-DOPA PET in patients with metastatic midgut neuroendocrine tumors Nicolas Deleval 1,2 & Louise Pesque 1,2 & Arnaud Dieudonné 1 & Flore Viry 3 & Olivia Hentic 4 & Rachida Lebtahi 1,2 & Philippe Ruszniewski 2,4,5 & Louis de Mestier 2,4,5 Received: 18 September 2020 / Accepted: 19 November 2020 # European Society of Radiology 2020
Abstract Objectives Bone metastases (BM) may influence negatively the prognosis of midgut neuroendocrine tumors (NET). The diagnostic sensitivity of 18F-DOPA PET for midgut NET and associated metastases is high. This study aimed to assess the prognostic impact of BM detected by 18F-DOPA PET in metastatic midgut NET. Methods All patients with a metastatic midgut NET, who underwent a 18F-DOPA PET between June 2011 and June 2018, were included. BM were defined following imaging criteria and were classified as poly-BM or oligo-BM, according to their number (< 5 or ≥ 5, respectively). The variables associated with the presence of BM were evaluated by logistic regression. The factors associated with overall survival were explored by Cox regression models. Results Among 155 patients included, 46 had BM (29.7%). A carcinoid syndrome (OR 2.96, p = 0.009) and ≥ 3 extra-skeletal metastatic organs (OR 4.99, p = 0.002) were independently associated with the presence of BM. BM were mainly osteoblastic (78%), rarely symptomatic (8.9%), and had a short-term therapeutic impact for 3 patients (6.5%). The presence of BM (HR 2.67, p = 0.034), older age (HR 1.07, p = 0.016), and higher Ki67 (HR 1.09, p = 0.025) were independent prognostic factors. Unlike poly-BM (HR 1.92, p = 0.007), oligo-BM was not a poor prognosis factor (HR 0.77, p = 0.699) compared to the group without BM. Conclusion 18F-DOPA PET frequently detects BM in patients with metastatic midgut NET. BM have a negative prognostic impact, especially poly-BM. Conversely, oligo-BM do not influence the prognosis and may not impact therapeutic decisions. Key Points • 18F-DOPA PET detected bone metastases in 46 (29.7%) of 155 patients with metastatic midgut neuroendocrine tumors. • Bone metastases have a negative prognostic impact in metastatic midgut neuroendocrine tumors. • Bone oligo-metastases (< 5) do not influence the prognosis and may not impact therapeutic decisions. Keywords Neuroendocrine tumors . Small intestine . 18F-DOPA PET . Bone metastases . Prognosis
Abbreviations F-DOPA 18Fluoro-dihydroxyphenylalanine BM Bone metastases NET Neuroendocrine tumors SUV Standardized uptake value 18
* Louis de Mestier [email protected] 1
Department of Nuclear Medicine, ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, France
2
Université de Paris, Paris, France
3
Department of Radiology, Lariboisière Hospital (APHP), Paris, France
4
Department of Gastroenterology and Pancreatology, ENETS Centre of Excellence, Beaujon Hospital (APHP), 100 boulevard du Général Leclerc, 92110 Clichy, France
5
INSERM U1149, Centre of Research in Inflammation, Beaujon Hospital, Clic
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