Giovacchini Giampiero, Incerti Elena, Mapelli Paola, Kirienko Margarita, Briganti Alberto, Gandaglia Giorgio, Montorsi Francesco, Gianolli Luigi, Picchio Maria
Department of Radiology and Nuclear Medicine, Stadtspital Triemli, Zurich, Switzerland.
Eur J Nucl Med Mol Imaging. 2015 May;42(6):877-84. doi: 10.1007/s00259-015-3015-8. Epub 2015 Feb 20.
Over the last decade, PET/CT with radiolabelled choline has been shown to be useful for restaging patients with prostate cancer (PCa) who develop biochemical failure. The limitations of most clinical studies have been poor validation of [(11)C]choline PET/CT-positive findings and lack of survival analysis. The aim of this study was to assess whether [(11)C]choline PET/CT can predict survival in hormone-naive PCa patients with biochemical failure.
This retrospective study included 302 hormone-naive PCa patients treated with radical prostatectomy who underwent [(11)C]choline PET/CT from 1 December 2004 to 31 July 2007 because of biochemical failure (prostate-specific antigen, PSA, >0.2 ng/mL). Median PSA was 1.02 ng/mL. PCa-specific survival was estimated using Kaplan-Meier curves. Cox regression analysis was used to evaluate the association between clinicopathological variables and PCa-specific survival. The coefficients of the covariates included in the Cox regression analysis were used to develop a novel nomogram.
Median follow-up was 7.2 years (1.4 - 18.9 years). [(11)C]Choline PET/CT was positive in 101 of 302 patients (33%). Median PCa-specific survival after prostatectomy was 14.9 years (95% CI 9.7 - 20.1 years) in patients with positive [(11)C]choline PET/CT. Median survival was not achieved in patients with negative [(11)C]choline PET/CT. The 15-year PCa-specific survival probability was 42.4% (95% CI 31.7 - 53.1%) in patients with positive [(11)C]choline PET/CT and 95.5% (95% CI 93.5 - 97.5 %) in patients with negative [(11)C]choline PET/CT. In multivariate analysis, [(11)C]choline PET/CT (hazard ratio 6.36, 95% CI 2.14 - 18.94, P < 0.001) and Gleason score >7 (hazard ratio 3.11, 95% CI 1.11 - 8.66, P = 0.030) predicted PCa-specific survival. An internally validated nomogram predicted 15-year PCa-specific survival probability with an accuracy of 80%.
Positive [(11)C]choline PET/CT after biochemical failure predicts PCa-specific survival in hormone-naive PCa patients. Prospective studies are warranted to confirm our results before more extensive use of [(11)C]choline PET/CT for prognostic stratification of PCa patients.
在过去十年中，已证明使用放射性标记胆碱的PET/CT对前列腺癌（PCa）出现生化复发的患者进行再分期是有用的。大多数临床研究的局限性在于对[(11)C]胆碱PET/CT阳性结果的验证不足以及缺乏生存分析。本研究的目的是评估[(11)C]胆碱PET/CT能否预测激素初治且出现生化复发的PCa患者的生存情况。
这项回顾性研究纳入了302例接受根治性前列腺切除术的激素初治PCa患者，这些患者因生化复发（前列腺特异性抗原，PSA，>0.2 ng/mL）于2004年12月1日至2007年7月31日接受了[(11)C]胆碱PET/CT检查。PSA中位数为1.02 ng/mL。使用Kaplan-Meier曲线估计PCa特异性生存率。采用Cox回归分析评估临床病理变量与PCa特异性生存率之间的关联。Cox回归分析中纳入的协变量系数用于构建一个新的列线图。
中位随访时间为7.2年（1.4 - 18.9年）。302例患者中有101例（33%）[(11)C]胆碱PET/CT呈阳性。[(11)C]胆碱PET/CT阳性的患者前列腺切除术后的中位PCa特异性生存时间为14.9年（95%CI 9.7 - 20.1年）。[(11)C]胆碱PET/CT阴性的患者未达到中位生存时间。[(11)C]胆碱PET/CT阳性的患者15年PCa特异性生存概率为42.4%（95%CI 31.7 - 53.1%），[(11)C]胆碱PET/CT阴性的患者为95.5%（95%CI 93.5 - 97.5%）。在多变量分析中，[(11)C]胆碱PET/CT（风险比6.36，95%CI 2.14 - 18.94，P < 0.001）和Gleason评分>7（风险比3.11，95%CI 1.11 - 8.66，P = 0.030）可预测PCa特异性生存。一个经过内部验证的列线图预测15年PCa特异性生存概率的准确率为80%。
生化复发后[(11)C]胆碱PET/CT阳性可预测激素初治PCa患者的PCa特异性生存。在更广泛地将[(11)C]胆碱PET/CT用于PCa患者的预后分层之前，有必要进行前瞻性研究以证实我们的结果。
