Prognostic value of baseline [68Ga]Ga‑DOTA‑NOC PET/CT in paediatric neuroblastoma.

<h4>Purpose</h4>To evaluate the prognostic value of baseline [⁶⁸Ga]Ga-DOTA-NOC PET/CT-derived volumetric and uptake parameters in paediatric neuroblastoma patients.<h4>Methods</h4>Sixty‑five newly diagnosed patients underwent baseline [⁶⁸Ga]Ga‑DOTA‑NOC PET/CT. Primary‑tumour and whole‑body metrics were measured: SUVmax, SUVmean, SUVpeak (standardized uptake values), Gross Tumour Volume (GTV), and Total Lesion NOC (TL‑NOC). Cox regression evaluated predictors of progression‑free survival (PFS) and overall survival (OS).<h4>Results</h4>Over a median 30‑month follow‑up (range 10-51), 20 progressed and 11 died. High‑risk cases (n = 38) had higher uptake and volumes than non high‑risk (n = 27): primary‑tumour and whole‑body SUVmax (p = 0.006 and 0.001); primary‑tumour SUVpeak (p = 0.013); whole‑body TL‑NOC(p = 0.001) and GTV (p = 0.016). On multivariable Cox analysis, primary‑tumour SUVmax (HR = 1.07, 95% CI: 1.02-1.12, P = 0.005) and SUVpeak (HR = 1.06, 95% CI: 1.01-1.11, P = 0.025), as well as whole‑body TL‑NOC (per 100 SUV × cm³; HR = 1.03, 95% CI: 1.01-1.05, P = 0.013), remained independently associated with PFS, whereas whole‑body TL‑NOC (per 100 SUV × cm³; HR = 1.07, 95% CI: 1.03-1.10, P = 0.001), whole‑body GTV (per 50 cm³; HR = 1.08, 95% CI: 1.01-1.16, P = 0.028) and primary‑tumour TL‑NOC (per 100 SUV × cm³; HR = 1.08, 95% CI: 1.01-1.15, P = 0.026) were independent predictors of OS. A whole‑body TL‑NOC > 1357.05 SUV × cm³ identified patients with significantly worse PFS and OS.<h4>Conclusion</h4>Parameters derived from [⁶⁸Ga]Ga‑DOTA‑NOC PET/CT, especially whole‑body TL‑NOC, are independent predictors of PFS and OS in neuroblastoma, supporting their use for risk stratification.