Our aim was to assess the prognostic and predictive value of somatostatin receptor 2 (sstr) in neuroendocrine tumors (NETs).

We established a tissue microarray and imaging database from NET patients that received sstr-targeted radiopeptide therapy with yttrium-90-DOTATOC, lutetium-177-DOTATOC or alternative treatment. We used univariate and multivariate analyses to identify prognostic and predictive markers for overall survival, including sstr-imaging and sstr-immunohistochemistry.

We included a total of 279 patients. In these patients, sstr-immunohistochemistry was an independent prognostic marker for overall survival (HR: 0.82, 95 % CI: 0.67 - 0.99, n = 279, p = 0.037). In DOTATOC patients, sstr-expression on immunohistochemistry correlated with tumor uptake on sstr-imaging (n = 170, p < 0.001); however, sstr-imaging showed a higher prognostic accuracy (positive predictive value: +27 %, 95 % CI: 3 - 56 %, p = 0.025). Sstr-expression did not predict a benefit of DOTATOC over alternative treatment (p = 0.93).

Our results suggest sstras an independent prognostic marker in NETs. Sstr-immunohistochemistry correlates with sstr-imaging; however, sstr-imaging is more accurate for determining the individual prognosis.