Research ArticleTheranostics

64Cu-DOTATATE PET/CT and Prediction of Overall and Progression-Free Survival in Patients with Neuroendocrine Neoplasms

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 and Andreas Kjaer
Journal of Nuclear Medicine October 2020, 61 (10) 1491-1497; DOI: https://doi.org/10.2967/jnumed.119.240143

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Box plot of 64Cu-DOTATATE SUVmax by WHO grade for 121 patients with NEN. G1, G2, and G3 = grades 1, 2, and 3, respectively.

  • FIGURE 2.
    FIGURE 2.

    Kaplan–Meier plots of outcome for 128 patients with NENs, stratified by 64Cu-DOTATATE SUVmax (reference: SUVmax ≤ 43.3). (A) PFS. (B) OS. CI = confidence interval.

  • FIGURE 3.
    FIGURE 3.

    Plot of hazard ratios (solid lines) with 95% confidence intervals (dotted lines) at several cutoffs for 64Cu-DOTATATE SUVmax. Vertical solid line indicates most significant cutoff for SUVmax (43.3 for PFS [A] and no significant cutoff identified for OS [B]). CI = confidence interval; HR = hazard ratio.

  • FIGURE 4.
    FIGURE 4.

    Kaplan–Meier plots of outcome for 121 patients with NENs, stratified by WHO grade (reference: grade 1). (A) PFS. (B) OS. CI = confidence interval; G1, G2, and G3 = grades 1, 2, and 3, respectively.

  • FIGURE 5.
    FIGURE 5.

    Forest plots of multiple Cox regression analyses to predict outcome in 128 patients with NENs. (A) PFS. (B) OS. CI = confidence interval; G1, G2, and G3 = grades 1, 2, and 3, respectively; HR = hazard ratio.

Tables

  • TABLE 1

    Baseline Characteristics of 128 Patients with NENs

    CharacteristicValue
    Age (y)Median, 63; range, 29–83
    Male/female (n)72/56 (56%/44%)
    Time from diagnosis to scan (mo)Median, 18; range, 0–208
    Primary tumor site (%)
     Lung7 (5)
     Unknown primary NEN23 (18)
     Stomach1 (1)
     Small intestine60 (47)
     Pancreas25 (20)
     Cecum8 (6)
     Extrahepatic biliary tract2 (2)
     Esophagus1 (1)
     Other1 (1)
    Primary tumor site, grouped (n)
     Lung7 (5%)
     Unknown primary NEN23 (18%)
     Gastrointestinal tract*73 (57%)
     Pancreas25 (20%)
    Ki-67 index (%)Median, 5; range, 1–100
    WHO grading (n)†
     Grade 131 (26%)
     Grade 284 (69%)
     Grade 36 (5%)
    Treatment before 64Cu-DOTATATE PET/CT (n)‡
     No treatment18 (14%)
     Localized treatment13 (10%)
     Systemic treatment43 (34%)
     Localized and  systemic treatment54 (42%)

    • ↵* Gastrointestinal collectively refers to primaries originating from stomach, small intestine, cecum, extrahepatic biliary tract, esophagus, or other.

    • ↵† Not available in 7 patients.

    • ↵‡ Localized treatment: surgery (n = 59), hepatic artery embolization (n = 9), radiofrequency ablation (n = 7), and/or external radiation (n = 2). Systemic treatment: interferon (n = 57), somatostatin analog (n = 49), chemotherapy (n = 49), and/or peptide receptor radionuclide therapy (n = 43).

  • TABLE 2

    64Cu-DOTATATE SUVmax in Tumor or Metastases in 128 Patients with NEN

    ParameterMeanP
    Overall62.2 (3.3)—
    Primary tumor site, grouped0.001*
     Lung (n = 7)63.2 (21.4)
     Pancreas (n = 25)83.8 (10.1)
     Gastrointestinal (n = 73)51.5 (2.9)
     Unknown primary NEN (n = 23)72.3 (7.5)
    WHO grade0.52
     Grade 1 (n = 31)67.4 (7.5)
     Grade 2 (n = 84)62.0 (3.8)
     Grade 3 (n = 6)48.7 (22.7)
    Overall survival at 24 mo0.06
     Alive (n = 99)65.6 (3.8)
     Deceased (n = 29)50.7 (5.7)
    PFS at 24 mo0.17
     No progression (n = 62)66.9 (5.0)
     Progression (n = 66)57.8 (4.3)

    • ↵* Post hoc analysis by Tukey identified P < 0.001 for pancreas vs. gastrointestinal SUVmax.

    • Data in parentheses are SEM.

    • PFS = progression-free survival.

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