Poulsen Mads H, Rasmussen Janne, Edenbrandt Lars, Høilund-Carlsen Poul F, Gerke Oke, Johansen Allan, Lund Lars
Department of Urology,, Odense University Hospital, Odense, Denmark.
Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
BJU Int. 2016 May;117(5):748-53. doi: 10.1111/bju.13160. Epub 2015 Jun 13.
To evaluate the Bone Scan Index (BSI) for prediction of castration resistance and prostate cancer-specific survival (PCSS). In this retrospective study, we used novel computer-assisted software for automated detection/quantification of bone metastases by BSI. Patients with prostate cancer are M-staged by whole-body bone scintigraphy (WBS) and categorised as M0 or M1. Within the M1 group, there is a wide range of clinical outcomes. The BSI was introduced a decade ago providing quantification of bone metastases by estimating the percentage of bone involvement. Being too time consuming, it never gained widespread clinical use.
In all, 88 patients with prostate cancer awaiting initiation of androgen-deprivation therapy due to metastases were included. WBS was performed using a two-headed γ-camera. BSI was obtained using the automated platform EXINI bone (EXINI Diagnostics AB, Lund, Sweden). In Cox proportional hazard models, time to castration-resistant prostate cancer (CRPC) and PCSS were modelled as the dependent variables, whereas prostate-specific antigen (PSA) level, Gleason score and BSI were used as explanatory factors. For Kaplan-Meier estimates, BSI groups were dichotomously split into: BSI <1 and BSI ≥1. Discrimination between prognostic models was explored using the concordance index (C-index).
The mean (range) age of the patients was 72 (52-92) years, the median (range) PSA level was 73 (4-5 740) ng/mL, the mean (range) Gleason score was 7.7 (2-10), and the mean (range) BSI was 1.0 (0-9.2). During a mean (range) follow-up of 26 (8-49) months, 48 patients became castration resistant and 15 had died; most (13) from prostate cancer. In multivariate analysis including PSA level, Gleason score and BSI, only prediction by BSI was statistically significant. This was true both for time to CRPC (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.22-1.74; C-index increase from 0.49 to 0.69) and for PCSS (HR 1.34, 95% CI 1.07-1.67; C-index increase from 0.76 to 0.95).
BSI obtained using a novel automated computer-assisted algorithm appears to be a useful predictor of outcome for time to CRPC and PCSS in patients with hormone-sensitive metastatic prostate cancer.
评估骨扫描指数（BSI）预测去势抵抗和前列腺癌特异性生存（PCSS）的能力。在这项回顾性研究中，我们使用新型计算机辅助软件通过BSI自动检测/定量骨转移。前列腺癌患者通过全身骨闪烁显像（WBS）进行M分期，分为M0或M1。在M1组中，临床结局差异很大。BSI于十年前推出，通过估计骨受累百分比来定量骨转移。由于耗时过长，它从未在临床上广泛应用。
总共纳入88例因转移而等待开始雄激素剥夺治疗的前列腺癌患者。使用双头γ相机进行WBS。使用自动化平台EXINI bone（瑞典隆德的EXINI Diagnostics AB公司）获得BSI。在Cox比例风险模型中，将去势抵抗性前列腺癌（CRPC）发生时间和PCSS作为因变量进行建模，而将前列腺特异性抗原（PSA）水平、Gleason评分和BSI用作解释因素。对于Kaplan-Meier估计，将BSI组二分法分为：BSI<1和BSI≥1。使用一致性指数（C指数）探索预后模型之间的区分度。
患者的平均（范围）年龄为72（52 - 92）岁，PSA水平的中位数（范围）为73（4 - 5740）ng/mL，Gleason评分的平均（范围）为7.7（2 - 10），BSI的平均（范围）为1.0（0 - 9.2）。在平均（范围）26（8 - 49）个月的随访期间，48例患者出现去势抵抗，15例死亡；大多数（13例）死于前列腺癌。在包括PSA水平、Gleason评分和BSI的多变量分析中，只有BSI的预测具有统计学意义。对于CRPC发生时间（风险比[HR] 1.45，95%置信区间[CI] 1.22 - 1.74；C指数从0.49增加到0.69）和PCSS（HR 1.34，95% CI 1.07 - 1.67；C指数从0.76增加到0.95）均如此。
使用新型自动化计算机辅助算法获得的BSI似乎是激素敏感性转移性前列腺癌患者CRPC发生时间和PCSS结局的有用预测指标。
