Kwee Sandi A, Lim John, Watanabe Alex, Kromer-Baker Kathleen, Coel Marc N
The Queen's Medical Center, Honolulu, Hawaii
The Queen's Medical Center, Honolulu, Hawaii Hamamatsu/Queen's PET Imaging Center, Honolulu, Hawaii; and.
J Nucl Med. 2014 Jun;55(6):905-10. doi: 10.2967/jnumed.113.135194. Epub 2014 Mar 27.
This study investigated the prognostic significance of metabolically active tumor volume (MATV) measurements applied to (18)F-fluorocholine PET/CT in castration-resistant prostate cancer (CRPC).
(18)F-fluorocholine PET/CT imaging was performed on 30 patients with CRPC. Metastatic disease was quantified on the basis of maximum standardized uptake value (SUV(max)), MATV, and total lesion activity (TLA = MATV × mean standardized uptake value). Tumor burden indices derived from whole-body summation of PET tumor volume measurements (i.e., net MATV and net TLA) were evaluated as variables in Cox regression and Kaplan-Meier survival analyses.
Net MATV ranged from 0.12 cm(3) to 1,543.9 cm(3) (median, 52.6 cm(3)). Net TLA ranged from 0.40 to 6,688.7 g (median, 225.1 g). Prostate-specific antigen level at the time of PET correlated significantly with net MATV (Pearson r = 0.65, P = 0.0001) and net TLA (r = 0.60, P = 0.0005) but not highest lesional SUV(max) of each scan. Survivors were followed for a median 23 mo (range, 6-38 mo). On Cox regression analyses, overall survival had a significant association with net MATV (P = 0.0068), net TLA (P = 0.0072), and highest lesion SUV(max) (P = 0.0173) and a borderline association with prostate-specific antigen level (P = 0.0458). Only net MATV and net TLA remained significant in univariate-adjusted survival analyses. Kaplan-Meier analysis demonstrated significant differences in survival between groups stratified by median net MATV (log-rank P = 0.0371), net TLA (log-rank P = 0.0371), and highest lesion SUV(max) (log-rank P = 0.0223).
Metastatic prostate cancer detected by (18)F-fluorocholine PET/CT can be quantified on the basis of volumetric measurements of tumor metabolic activity. The prognostic value of (18)F-fluorocholine PET/CT may stem from this capacity to assess whole-body tumor burden. With further clinical validation, (18)F-fluorocholine PET-based indices of global disease activity and mortality risk could prove useful in patient-individualized treatment of CRPC.
本研究调查了应用于去势抵抗性前列腺癌（CRPC）的（18）F - 氟胆碱PET/CT测量的代谢活性肿瘤体积（MATV）的预后意义。
对30例CRPC患者进行（18）F - 氟胆碱PET/CT成像。根据最大标准化摄取值（SUV（max））、MATV和总病变活性（TLA = MATV×平均标准化摄取值）对转移疾病进行量化。源自PET肿瘤体积测量全身总和的肿瘤负荷指数（即净MATV和净TLA）在Cox回归和Kaplan - Meier生存分析中作为变量进行评估。
净MATV范围为0.12 cm³至1543.9 cm³（中位数，52.6 cm³）。净TLA范围为0.40至6688.7 g（中位数，225.1 g）。PET检查时的前列腺特异性抗原水平与净MATV（Pearson r = 0.65，P = 0.0001）和净TLA（r = 0.60，P = 0.0005）显著相关，但与每次扫描的最高病变SUV（max）无关。对幸存者进行了中位数为23个月（范围，6 - 38个月）的随访。在Cox回归分析中，总生存与净MATV（P = 0.0068）、净TLA（P = 0.0072）和最高病变SUV（max）（P = 0.0173）显著相关，与前列腺特异性抗原水平存在临界相关性（P = 0.0458）。在单变量调整生存分析中，只有净MATV和净TLA仍然显著。Kaplan - Meier分析表明，按净MATV中位数（对数秩P = 0.0371）、净TLA（对数秩P = 0.0371）和最高病变SUV（max）（对数秩P = 0.0223）分层的组间生存存在显著差异。
通过（18）F - 氟胆碱PET/CT检测到的转移性前列腺癌可根据肿瘤代谢活性的体积测量进行量化。（18）F - 氟胆碱PET/CT的预后价值可能源于这种评估全身肿瘤负荷的能力。经过进一步临床验证，基于（18）F - 氟胆碱PET的整体疾病活性和死亡风险指标可能对CRPC患者个体化治疗有用。
