Prognostic value of the dual-tracer PET score (NETPET) in neuroendocrine tumors with [<sup>225</sup>Ac]Ac-DOTATATE therapy.

Abstract

PurposeTo investigate the association between baseline NETPET score and prognosis in patients with neuroendocrine tumors (NETs) receiving [225Ac]Ac-DOTATATE therapy.MethodsThis retrospective study included patients with NETs treated with [225Ac]Ac-DOTATATE between November 2021 and March 2025. All patients underwent [18F]F-FDG and [68Ga]Ga-DOTATATE PET within one week before treatment. Up to 10 representative lesions per patient were selected for NETPET scoring. The primary endpoint was progression-free survival (PFS). The relationship between NETPET score and PFS was evaluated using Kaplan-Meier analysis and univariate/multivariate Cox proportional hazards models.ResultsForty-eight patients were enrolled (P1: n = 14, P2-4: n = 22, P5: n = 12). The P1 group achieved significantly better PFS than the P2-4 and P5 groups (2-year PFS rates: 0.83 vs. 0.32 vs. 0.10; log-rank P 0.05).ConclusionThe NETPET score was independently associated with progression-free survival and may serve as a potential imaging biomarker for pretreatment risk stratification in NET patients receiving [225Ac]Ac-DOTATATE therapy.