Ga-68-Edotreotide Positron Emission Tomography/Computed Tomography Somatostatin Receptors Tumor Volume Predicts Outcome in Patients With Primary Gastroenteropancreatic Neuroendocrine Tumors

Background: We retrospectively aimed to assess the prognostic significance of somatostatin receptor (SSTR) standardized uptake value (SUVmax_sstr), SSTR representative tumor volume (RTV_sstr) and total lesion SSTR expression (TL_sstr) obtained by [⁶⁸Ga]Ga-edotreotide PET/CT ([⁶⁸Ga]Ga-SSTR PET/CT) in patients with primary gastroenteropancreatic neuroendocrine tumors (GEP-NET) before surgery.

Material and methods: We analyzed patients who underwent [⁶⁸Ga]Ga-SSTR PET/CT 3-6 weeks before surgery from February 2020 to April 2022. The mean SUVmax_sstr value, the RTV_sstr (cm3; 42% threshold) and the TL_sstr (g) were registered. Thereafter the patients were followed up 10.3 months (range 3-27). The PET/CT results were compared to the event free survival (EFS).

Results: Forty-two patients (61 ± 13 years) have been enrolled. At multivariate analysis only RTV_sstr values were predictive. The Kaplan-Meier survival analysis for RTV_sstr showed a significant better EFS in patients presenting lower values as compared to those having greater (P = .003, log-rank test). SUVmax_sstr was not suitable for predicting EFS, TL_sstr mildly.

Conclusion: RTV_sstr represents a valuable volumetric parameter able to predict the outcome in GEP-NET patients who underwent surgery. The magnitude of the SSTR representative tumor burden holds a predominant value for determining the response to therapy in GEP-NET patients before surgery, rather than the maximal SSTR representation at single voxel.

gastoenteropancreatic tumors-neuroendocrine tumors; positron emission tomography/computed tomography; quantitative assessment; survival; volumetric parameters.