title: Prognostic Value of 68Ga-DOTANOC PET/CT SUVmax in Patients with Neuroendocrine Tumors of the Pancreas.
abstract: This study was performed to investigate the role of (68)Ga-DOTANOC SUVmax as a potential prognostic factor in patients with pancreatic neuroendocrine tumor (pNET).
  
  
  METHODS
  Among the patients who underwent (68)Ga-DOTANOC PET/CT, we retrospectively collected the data of those who had G1 or G2 pNET (2010 World Health Organization classification), presented with disease on PET/CT and CT, and had at least 6 mo of follow-up. Patients with multiple endocrine neoplasia were excluded.
  
  
  RESULTS
  Overall, 43 patients were included. No significant differences in SUVmax were observed with respect to sex, tumor syndrome, stage, World Health Organization classification, or Ki-67. During follow-up (median, 20 mo), 11 patients (35.6%; median, 33 mo; interquartile range, 20-48 mo) had stable disease and 32 (74.4%; median, 19 mo; interquartile range, 14-26 mo) had progressive disease. SUVmax at 24 mo of follow-up was significantly higher (P = 0.022) in patients with stable disease than in patients with progressive disease. The best SUVmax cutoff ranged from 37.8 to 38.0. The major risk factors for progression included an SUVmax of no more than 37.8 (hazard ratio, 3.09; P = 0.003), a Ki-67 of more than 5% (hazard ratio, 2.89; P = 0.009), and medical therapy alone (hazard ratio, 2.36; P = 0.018). Advanced stage (IV) (P = 0.026), an SUVmax of less than 37.8 (P = 0.043), and medical therapy alone (P = 0.015) were also confirmed at multivariate analysis. Median progression-free survival was 23 mo. Significant differences in progression-free survival were observed in relationship to Ki-67 (median, 45 mo for Ki-67 ≤ 5% and 20 mo for Ki-67 > 5%; P = 0.005), SUVmax (<37.8 vs. >38.0: 16.0 vs. 27.0 mo; P = 0.002), and type of therapy (medical vs. peptide receptor radionuclide therapy: 16.0 vs. 26.0 mo; P = 0.014).
  
  
  CONCLUSIONS
  (68)Ga-DOTANOC SUVmax is a relevant prognostic factor in patients with G1 and G2 pNET, and its routine use will improve disease characterization and management in these patients, who may present with atypical cases showing heterogeneous clinical behavior.
authors.affiliation: Nuclear Medicine, Department of Experimental Diagnostic and Specialized Medicine, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy; and valentina.ambrosini@unibo.it.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ambrosini
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Campana
authors.affiliation: Nuclear Medicine, Department of Experimental Diagnostic and Specialized Medicine, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy; and.
authors.forename: Giulia
authors.initials: G
authors.lastname: Polverari
authors.affiliation: Nuclear Medicine, Department of Experimental Diagnostic and Specialized Medicine, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy; and.
authors.forename: Chiara
authors.initials: C
authors.lastname: Peterle
authors.affiliation: Nuclear Medicine, Department of Experimental Diagnostic and Specialized Medicine, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy; and.
authors.forename: Stefania
authors.initials: S
authors.lastname: Diodato
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ricci
authors.affiliation: Nuclear Medicine, Department of Experimental Diagnostic and Specialized Medicine, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy; and.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Allegri
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tomassetti
authors.affiliation: Nuclear Medicine, Department of Experimental Diagnostic and Specialized Medicine, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy; and.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019394:Ki-67 Antigen; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy; D009942:Organometallic Compounds; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: C504894:68Ga-DOTANOC; D019394:Ki-67 Antigen; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals
keywords: 68Ga-DOTA-NOC; NET; PET/CT; SUVmax; pancreas