Etchebehere Elba C, Milton Denái R, Araujo John C, Swanston Nancy M, Macapinlac Homer A, Rohren Eric M
Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler, FCT 16.6005, Unit 1483, Houston, TX, 77030, USA.
Department of Nuclear Medicine, Campinas State University (Unicamp), Rua Vital Brasil, 251, Cx.Postal. 6142, Cidade Universitária Zeferino Vaz, 13083-888, Campinas, Brazil.
Eur J Nucl Med Mol Imaging. 2016 Jan;43(1):8-20. doi: 10.1007/s00259-015-3185-4. Epub 2015 Sep 29.
The aim of this study was to identify baseline features that predict outcome in (223)Ra therapy.
We retrospectively reviewed 110 patients with metastatic castration-resistant prostate cancer treated with (223)Ra. End points were overall survival (OS), progression-free survival (PFS), bone event-free survival (BeFS), and bone marrow failure (BMF). The following parameters were evaluated prior to the first (223)Ra cycle: serum levels of hemoglobin (Hb), prostate-specific antigen (PSA), alkaline phosphatase (ALP), Eastern Cooperative Oncology Group (ECOG) status, pain score, use of chemotherapy, and external beam radiation therapy (EBRT). During/after (223)Ra we evaluated: the total number of radium cycles (RaTot), the PSA doubling time (PSADT), and the use of chemotherapy, EBRT, abiraterone, and enzalutamide.
A significant reduction of ALP (p < 0.001) and pain score (p = 0.041) occurred throughout the (223) Ra cycles. The risk of progression was associated with declining ECOG status [hazard ratio (HR) = 3.79; p < 0.001] and decrease in PSADT (HR = 8.22; p < 0.001). RaTot, ALP, initial ECOG status, initial pain score, and use of abiraterone were associated with OS (p ≤ 0.008), PFS (p ≤ 0.003), and BeFS (p ≤ 0.020). RaTot, ALP, initial ECOG status, and initial pain score were significantly associated with BMF (p ≤ 0.001) as well as Hb (p < 0.001) and EBRT (p = 0.009). On multivariable analysis, only RaTot and abiraterone remained significantly associated with OS (p < 0.001; p = 0.033, respectively), PFS (p < 0.001; p = 0.041, respectively), and BeFS (p < 0.001; p = 0.019, respectively). Additionally, RaTot (p = 0.027) and EBRT (p = 0.013) remained significantly associated with BMF.
Concomitant use of abiraterone and (223)Ra seems to have a beneficial effect, while the EBRT may increase the risk of BMF.
本研究旨在确定能预测镭-223治疗效果的基线特征。
我们回顾性分析了110例接受镭-223治疗的转移性去势抵抗性前列腺癌患者。终点指标为总生存期（OS）、无进展生存期（PFS）、无骨事件生存期（BeFS）和骨髓衰竭（BMF）。在首个镭-223治疗周期前评估以下参数：血红蛋白（Hb）、前列腺特异性抗原（PSA）、碱性磷酸酶（ALP）的血清水平、东部肿瘤协作组（ECOG）状态、疼痛评分、化疗使用情况以及外照射放疗（EBRT）。在镭-223治疗期间/之后，我们评估了：镭周期总数（RaTot）、PSA倍增时间（PSADT）以及化疗、EBRT、阿比特龙和恩杂鲁胺的使用情况。
在整个镭-223治疗周期中，ALP（p < 0.001）和疼痛评分（p = 0.041）显著降低。疾病进展风险与ECOG状态下降[风险比（HR）= 3.79；p < 0.001]和PSADT降低（HR = 8.22；p < 0.001）相关。RaTot、ALP、初始ECOG状态、初始疼痛评分以及阿比特龙的使用与OS（p ≤ 0.008）、PFS（p ≤ 0.003）和BeFS（p ≤ 0.020）相关。RaTot、ALP、初始ECOG状态和初始疼痛评分与BMF（p ≤ 0.001）以及Hb（p < 0.001）和EBRT（p = 0.009）显著相关。多变量分析显示，仅RaTot和阿比特龙与OS（分别为p < 0.001；p = 0.033）、PFS（分别为p < 0.001；p = 0.041）和BeFS（分别为p < 0.001；p = 0.019）仍显著相关。此外，RaTot（p = 0.027）和EBRT（p = 0.013）与BMF仍显著相关。
阿比特龙与镭-223联合使用似乎具有有益效果，而EBRT可能会增加BMF的风险。
