Neuroendocrine liver metastases treated using transarterial radioembolization: Identification of prognostic parameters at 68Ga-DOTATATE PET/CT

IF 4.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Diagnostic and Interventional Imaging Pub Date : 2024-01-01 DOI:10.1016/j.diii.2023.06.007

Maria Ingenerf , Freba Grawe , Michael Winkelmann , Homeira Karim , Johannes Ruebenthaler , Matthias Philipp Fabritius , Jens Ricke , Ricarda Seidensticker , Christoph Josef Auernhammer , Mathias Johannes Zacherl , Max Seidensticker , Christine Schmid-Tannwald

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Abstract

Purpose

To identify prognostic clinical and imaging parameters for patients with neuroendocrine liver metastases (NELMs) undergoing transarterial radioembolization (TARE).

Materials and methods

Forty-seven patients (27 men; mean age, 64 years) with NELMs who received TARE, along with pre-procedure liver MRI and ⁶⁸Ga-DOTATATE positron emission tomography/computed tomography were included. Apparent diffusion coefficient and standardized uptake value (SUV) of three liver metastases, normal spleen and liver were measured. SUVmax or SUVmean were used for the calculation of tumor-to-organ ratios (tumor-to-spleen and tumor-to-liver ratios) using all possible combinations (including SUVmax/SUVmax, SUVmax/SUVmean, and SUVmean/SUVmean). Clinical parameters (hepatic tumor-burden, presence of extra-hepatic metastases, chromograninA, Ki-67 and bilirubin levels) were assessed. Overall survival, progression-free survival (PFS) and hepatic progression-free survival (HPFS) were calculated using Kaplan-Meier curves.

Results

Median overall survival, PFS and HPFS were 49.6, 13.1 and 28.3 months, respectively. In multivariable Cox regression analysis, low Ki-67 (≤ 5%), low hepatic tumor-burden (< 10%), absence of extrahepatic metastases, and increased Tmean/Lmax ratio were significant prognostic factors of longer overall survival and HPFS. High baseline chromograninA (> 1330 ng/mL) was associated with shorter HPFS. Tmean/Lmax > 1.9 yielded a median overall survival of 69 vs. 33 months (P < 0.04), and a median HPFS of 30 vs. 19 months (P = 0.09). For PFS, high baseline SUVmax of NELMs was the single significant parameter in the multivariable model. SUVmax > 28 resulted in a median PFS of 16.9 vs. 6.5 months, respectively (P = 0.001).

Conclusion

High preinterventional Tmean/Lmax ratios, and high SUVmax on ⁶⁸Ga-DOTATATE positron emission tomography/computed tomography seem to have prognostic value in patients with NELMs undergoing TARE, potentially aiding patient selection and management alongside conventional variables.

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使用经动脉放射栓塞治疗神经内分泌肝转移瘤：通过 68Ga-DOTATATE PET/CT 确定预后参数

目的确定接受经动脉放射栓塞术（TARE）的神经内分泌肝转移瘤（NELMs）患者的临床和影像学预后参数。材料和方法纳入接受 TARE 的 47 例 NELMs 患者（27 例男性，平均年龄 64 岁），并进行术前肝脏 MRI 和 68Ga-DOTATATE 正电子发射断层扫描/计算机断层扫描。测量了三个肝转移灶、正常脾脏和肝脏的表观弥散系数和标准化摄取值（SUV）。采用所有可能的组合（包括 SUVmax/SUVmax、SUVmax/SUVmean 和 SUVmean/SUVmean），用 SUVmax 或 SUVmean 计算肿瘤器官比（肿瘤脾脏比和肿瘤肝脏比）。对临床参数（肝脏肿瘤负担、肝外转移灶、嗜铬粒蛋白 A、Ki-67 和胆红素水平）进行了评估。结果中位总生存期、无进展生存期和无肝转移生存期分别为49.6个月、13.1个月和28.3个月。在多变量 Cox 回归分析中，低 Ki-67（≤ 5%）、低肝肿瘤负担（< 10%）、无肝外转移和 Tmean/Lmax 比值增加是延长总生存期和 HPFS 的重要预后因素。高基线嗜铬粒蛋白A（1330纳克/毫升）与较短的HPFS相关。Tmean/Lmax为1.9时，中位总生存期为69个月对33个月（P = 0.04），中位HPFS为30个月对19个月（P = 0.09）。就PFS而言，NELMs基线SUVmax高是多变量模型中唯一重要的参数。结论介入前的高Tmean/Lmax比值和68Ga-DOTATATE正电子发射断层扫描/计算机断层扫描的高SUVmax似乎对接受TARE治疗的NELMs患者具有预后价值，可能有助于患者的选择和管理以及常规变量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnostic and Interventional Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

8.50

自引率

29.10%

发文量

126

审稿时长

11 days

期刊介绍： Diagnostic and Interventional Imaging accepts publications originating from any part of the world based only on their scientific merit. The Journal focuses on illustrated articles with great iconographic topics and aims at aiding sharpening clinical decision-making skills as well as following high research topics. All articles are published in English. Diagnostic and Interventional Imaging publishes editorials, technical notes, letters, original and review articles on abdominal, breast, cancer, cardiac, emergency, forensic medicine, head and neck, musculoskeletal, gastrointestinal, genitourinary, interventional, obstetric, pediatric, thoracic and vascular imaging, neuroradiology, nuclear medicine, as well as contrast material, computer developments, health policies and practice, and medical physics relevant to imaging.