TY - JOUR T1 - High Prognostic Value of <sup>18</sup>F-FDG PET for Metastatic Gastroenteropancreatic Neuroendocrine Tumors: A Long-Term Evaluation JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1786 LP - 1790 DO - 10.2967/jnumed.114.144386 VL - 55 IS - 11 AU - Haïfa Bahri AU - Lenoir Laurence AU - Julien Edeline AU - Houda Leghzali AU - Anne Devillers AU - Jean-Luc Raoul AU - Marc Cuggia AU - Habiba Mesbah AU - Bruno Clement AU - Eveline Boucher AU - Etienne Garin Y1 - 2014/11/01 UR - http://jnm.snmjournals.org/content/55/11/1786.abstract N2 - This study aimed to evaluate the long-term prognostic usefulness of 18F-FDG PET for patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEPNETs). Methods: Thirty-eight patients with metastatic GEPNETs were prospectively enrolled. Initial check-up comprised CT scan, 111In-pentetreotide scintigraphy (SRS), and 18F-FDG PET. Only 18F-FDG PET–positive lesions with a maximum standardized uptake value (SUVmax) greater than 4.5 or an SUV ratio (SUVmax tumor to SUVmax nontumoral liver tissue, or T/NT ratio) of 2.5 or greater were considered positive for prognosis—that is, indicating a poor prognosis. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Factors associated with survival were assessed with univariate and multivariate analyses, using the Cox regression model. Results: Median PFS and OS were significantly higher for patients with a negative 18F-FDG PET finding, with an OS of 119.5 mo (95% confidence interval [CI], 72–∞), than for patients with a positive 18F-FDG PET finding (only 15 mo [95% CI, 4–27]) (P &lt; 10−3). Median PFS and OS were significantly higher for the patient group that had a positive SRS than the group with a negative SRS (P = 0.0002). For patients with a positive SRS, PFS and OS were significantly shorter when the 18F-FDG PET finding was positive: 19.5 mo (95% CI, 4–37) for PFS and 119.5 mo (95% CI, 81–∞) for OS (P &lt; 10−3). In the patient group with a low-grade GEPNET and a positive SRS, PFS and OS were also significantly lower for patients with a positive 18F-FDG PET. At 48-mo follow-up, 100% of patients who had a positive 18F-FDG PET for disease progression (of which 47% were also SRS-positive) were deceased, and 87% of patients with a negative 18F-FDG PET were alive (P &lt; 0.0001). The T/NT ratio was the only parameter associated with OS on multivariate analysis. Conclusion: Overall, 18F-FDG PET appears to be of major importance in the prognostic evaluation of metastatic GEPNET. A positive 18F-FDG PET with an SUV ratio (T/NT) of 2.5 or greater was a poor prognostic factor, with a 4-y survival rate of 0%. A positive SRS does not eliminate the need for performing 18F-FDG PET, which is of greater prognostic utility. ER -