Abstract
The clinical relevance of bone metastases (BM) in advanced pancreatic
neuroendocrine tumors (PanNETs) is poorly described. We analyzed 314 consecutive
PanNET patients treated at the European Neuroendocrine Tumour Society (ENETS)
Center Essen between 2009 and 2021 in terms of the occurrence and clinical and
prognostic impact of BM using hybrid imaging with 68Ga-DOTATOC PET/CT.
According to UICC staging, 171/314 (54.5%) patients had stage IV
PanNETs. BM was diagnosed in 62/171 (36.3%) patients. Initially,
35% of BMs were visible by pathological tracer uptake only.
Skeletal-related events (SREs) were detected in 11 of the 62 patients
(17.7%). Patients with antiresorptive therapy had a significantly lower
rate of SRE (2/36, 5.6%) than individuals without bone-specific
therapy (9/26, 34.6%) (odds ratio 9.0, p=0.0054,
Fisher’s exact test). The median overall survival (OS) was 82 months
(53.6–110.4, 95% CI) in the stage IV PanNET cohort. The median
OS was significantly lower for patients with BM (63 months; 49.9–76.0,
95% CI) than for patients with distant metastases other than BM (116
months; 87.6–144.3, 95% CI) (p=0.016, log-rank test). BM
occurs in more than one-third of advanced PanNETs and is associated with an
unfavorable prognosis. One in five patients experiences a persistent
quality-of-life-lowering SRE. Antiresorptive therapy is associated with a more
favorable risk of SREs and should be offered to all patients with BM in
PanNETs.
Key words
pancreas - neuroendocrine tumour - bone metastases
