Camilla B Johnbeck1,2, Ulrich Knigge2,3, Seppo W Langer2,4, Annika Loft1,2, Anne Kiil Berthelsen1,2, Birgitte Federspiel2,5, Tina Binderup1,2, Andreas Kjaer6,2. 1. Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Cophenhagen, Denmark. 2. ENETS Neuroendocrine Tumor Center of Excellence, Rigshospitalet, Copenhagen, Denmark. 3. Department of Surgical Gastroenterology and Department of Clinical Endocrinology, Rigshospitalet, Copenhagen, Denmark. 4. Department of Oncology, Rigshospitalet, Copenhagen, Denmark; and. 5. Department of Pathology, Rigshospitalet, Copenhagen, Denmark. 6. Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Cophenhagen, Denmark akjaer@sund.ku.dk.
Abstract
Neuroendocrine neoplasms (NENs) constitute a heterogeneous group of tumors arising in various organs and with a large span of aggressiveness and survival rates. The Ki-67 proliferation index is presently used as the key marker of prognosis, and treatment guidelines are largely based on this index. 3'-deoxy-3'-18F-fluorothymidine (18F-FLT) is a proliferation tracer for PET imaging valuable in the monitoring of disease progression and treatment response in various types of cancer. However, until now only data from 10 patients with NEN were available in the literature. The aim of the present study was to investigate 18F-FLT PET as a prognostic marker for NENs in comparison with 18F-FDG PET and Ki-67 index. METHODS: One hundred patients were PET-scanned with both 18F-FLT and 18F-FDG within the same week, and the prognostic value of a positive scan was examined in terms of progression-free survival (PFS) and overall survival (OS). The correlation between the Ki-67 index and 18F-FLT uptake was also investigated. RESULTS: Thirty-seven percent of patients had a positive 18F-FLT PET scan, and 49% had 18F-FDG PET-positive foci. Patients with a high 18F-FLT uptake had a significantly shorter OS and PFS than patients with low or no 18F-FLT uptake. No correlation was found between Ki-67 index and 18F-FLT uptake. In a multivariate analysis 18F-FLT, 18F-FDG, and Ki-67 all were significant prognostic markers of PFS. For OS, only 18F-FDG and Ki-67 remained significant. CONCLUSION: 18F-FLT PET has prognostic value in NEN patients but when 18F-FDG PET and Ki-67 index are also available, a multivariate model revealed that 18F-FLT PET only adds information regarding PFS but not OS, whereas 18F-FDG PET remains predictive of both PFS and OS. However, a clinically robust algorithm including 18F-FLT in addition to 18F-FDG and Ki-67 could not be found. Accordingly, the exact role, if any, of 18F-FLT PET in NENs remains to be established.
Neuroendocrine neoplasms (NENs) constitute a heterogeneous group of tumors arising in various organs and with a large span of aggressiveness and survival rates. The Ki-67 proliferation index is presently used as the key marker of prognosis, and treatment guidelines are largely based on this index. 3'-deoxy-3'-18F-fluorothymidine (18F-FLT) is a proliferation tracer for PET imaging valuable in the monitoring of disease progression and treatment response in various types of cancer. However, until now only data from 10 patients with NEN were available in the literature. The aim of the present study was to investigate 18F-FLT PET as a prognostic marker for NENs in comparison with 18F-FDG PET and Ki-67 index. METHODS: One hundred patients were PET-scanned with both 18F-FLT and 18F-FDG within the same week, and the prognostic value of a positive scan was examined in terms of progression-free survival (PFS) and overall survival (OS). The correlation between the Ki-67 index and 18F-FLT uptake was also investigated. RESULTS: Thirty-seven percent of patients had a positive 18F-FLT PET scan, and 49% had 18F-FDG PET-positive foci. Patients with a high 18F-FLT uptake had a significantly shorter OS and PFS than patients with low or no 18F-FLT uptake. No correlation was found between Ki-67 index and 18F-FLT uptake. In a multivariate analysis 18F-FLT, 18F-FDG, and Ki-67 all were significant prognostic markers of PFS. For OS, only 18F-FDG and Ki-67 remained significant. CONCLUSION: 18F-FLT PET has prognostic value in NEN patients but when 18F-FDG PET and Ki-67 index are also available, a multivariate model revealed that 18F-FLT PET only adds information regarding PFS but not OS, whereas 18F-FDG PET remains predictive of both PFS and OS. However, a clinically robust algorithm including 18F-FLT in addition to 18F-FDG and Ki-67 could not be found. Accordingly, the exact role, if any, of 18F-FLT PET in NENs remains to be established.
Authors: Esben Andreas Carlsen; Camilla Bardram Johnbeck; Tina Binderup; Mathias Loft; Andreas Pfeifer; Jann Mortensen; Peter Oturai; Annika Loft; Anne Kiil Berthelsen; Seppo W Langer; Ulrich Knigge; Andreas Kjaer Journal: J Nucl Med Date: 2020-02-28 Impact factor: 10.057
Authors: Tina Binderup; Ulrich Knigge; Camilla Bardram Johnbeck; Annika Loft; Anne Kiil Berthelsen; Peter Oturai; Jann Mortensen; Birgitte Federspiel; Seppo W Langer; Andreas Kjaer Journal: J Nucl Med Date: 2020-10-16 Impact factor: 10.057
Authors: David L Chan; Gary A Ulaner; David Pattison; David Wyld; Rahul Ladwa; Julian Kirchner; Bob T Li; W Victoria Lai; Nick Pavlakis; Paul J Roach; Dale L Bailey Journal: J Nucl Med Date: 2021-02-12 Impact factor: 10.057