目的：本研究旨在阐明定量 SSTR-PET 指标和临床病理学生物标志物在接受肽受体放射性核素疗法 (PRRT) 治疗的神经内分泌肿瘤 (NET) 的无进展生存期 (PFS) 和总生存期 (OS) 中的作用。方法：对 91 名完成四个周期标准 177Lu-DOTATATE 的 NET 患者（M47/F44；年龄 66 岁，范围 34-90 岁）进行回顾性分析。使用半自动工作流程从治疗前 SSTR-PET 图像中分割出喜爱 SSTR 的肿瘤，并根据解剖区域标记肿瘤。针对 PRRT 反应，分析了多个基于图像的特征，包括总肿瘤体积和器官特异性肿瘤体积和 SSTR 密度，以及临床病理学生物标志物，包括 Ki-67、嗜铬粒蛋白 A (CgA) 和碱性磷酸酶 (ALP)。结果：中位 OS 为 39.4 个月（95% CI：33.1-NA 个月），中位 PFS 为 23.9 个月（95% CI：19.3-32.4 个月）。 SSTR 总肿瘤体积（HR = 3.6；P = 0.07）和骨肿瘤体积（HR = 1.5；P = 0.003）与较短的 OS 相关。此外，总肿瘤体积（HR = 4.3；P = 0.01）、肝肿瘤体积（HR = 1.8；P = 0.05）和骨肿瘤体积（HR = 1.4；P = 0.01）与较短的 PFS 相关。此外，大病灶体积和低 SSTR 摄取与较差的 OS（HR = 1.4；P = 0.03）和 PFS（HR = 1.5；P = 0.003）相关。在生物标志物中，基线 CgA 和 ALP 升高与 OS（CgA：HR = 4.9；P = 0.003，ALP：HR = 52.6；P = 0.004）和 PFS（CgA：HR = 4.2；P = 0.002）呈负相关。碱性磷酸酶：HR = 9.4；P = 0.06）。同样，既往全身治疗次数与较短的 OS（HR = 1.4；P = 0.003）和 PFS（HR = 1.2；P = 0.05）相关。此外，与胰腺（HR = 1.6；P = 0.16）和未知原发部位的肿瘤（HR = 3.0；P = 0.002）相比，源自中肠原发部位的肿瘤表现出更长的 PFS。结论：基于图像的特征，例如 SSTR 强烈的肿瘤体积、骨肿瘤受累以及低 SSTR 表达的大肿瘤的存在，证明了对 PFS 的显着预测价值，表明在 NET 管理中具有潜在的临床实用性。此外，CgA 和 ALP 升高，以及先前全身治疗次数的增加，成为与 PRRT 结果较差相关的重要因素。© 作者。

Purpose: This study aims to elucidate the role of quantitative SSTR-PET metrics and clinicopathological biomarkers in the progression-free survival (PFS) and overall survival (OS) of neuroendocrine tumors (NETs) treated with peptide receptor radionuclide therapy (PRRT). Methods: A retrospective analysis including 91 NET patients (M47/F44; age 66 years, range 34-90 years) who completed four cycles of standard 177Lu-DOTATATE was conducted. SSTR-avid tumors were segmented from pretherapy SSTR-PET images using a semiautomatic workflow with the tumors labeled based on the anatomical regions. Multiple image-based features including total and organ-specific tumor volume and SSTR density along with clinicopathological biomarkers including Ki-67, chromogranin A (CgA) and alkaline phosphatase (ALP) were analyzed with respect to the PRRT response. Results: The median OS was 39.4 months (95% CI: 33.1-NA months), while the median PFS was 23.9 months (95% CI: 19.3-32.4 months). Total SSTR-avid tumor volume (HR = 3.6; P = 0.07) and bone tumor volume (HR = 1.5; P = 0.003) were associated with shorter OS. Also, total tumor volume (HR = 4.3; P = 0.01), liver tumor volume (HR = 1.8; P = 0.05) and bone tumor volume (HR = 1.4; P = 0.01) were associated with shorter PFS. Furthermore, the presence of large lesion volume with low SSTR uptake was correlated with worse OS (HR = 1.4; P = 0.03) and PFS (HR = 1.5; P = 0.003). Among the biomarkers, elevated baseline CgA and ALP showed a negative association with both OS (CgA: HR = 4.9; P = 0.003, ALP: HR = 52.6; P = 0.004) and PFS (CgA: HR = 4.2; P = 0.002, ALP: HR = 9.4; P = 0.06). Similarly, number of prior systemic treatments was associated with shorter OS (HR = 1.4; P = 0.003) and PFS (HR = 1.2; P = 0.05). Additionally, tumors originating from the midgut primary site demonstrated longer PFS, compared to the pancreas (HR = 1.6; P = 0.16), and those categorized as unknown primary (HR = 3.0; P = 0.002). Conclusion: Image-based features such as SSTR-avid tumor volume, bone tumor involvement, and the presence of large tumors with low SSTR expression demonstrated significant predictive value for PFS, suggesting potential clinical utility in NETs management. Moreover, elevated CgA and ALP, along with an increased number of prior systemic treatments, emerged as significant factors associated with worse PRRT outcomes.© The author(s).