Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
J Nucl Med. 2018 Apr;59(4):596-602. doi: 10.2967/jnumed.117.195677. Epub 2017 Sep 1.
The aim of this study was to investigate the prognostic value of the quantitative assessment of skeletal tumor burden on bone scintigraphy (Bone Scan Index [BSI]) in patients who have advanced metastatic castration-resistant prostate cancer (mCRPC) and are receiving RaCl We hypothesized that the BSI can serve as a prognostic biomarker of overall survival (OS) and hematologic toxicity and as a tool for response assessment in patients with mCRPC treated with RaCl This study was a retrospective investigation of a Danish cohort of mCRPC patients who received RaCl therapy between March 2014 and October 2015 and for whom baseline bone scintigraphy was available. Bone scintigraphy studies were reviewed and graded according to the extent of disease. Furthermore, an automated BSI (EXINI Bone) was obtained for baseline scintigraphy studies and follow-up scans after 3 cycles as well as at the end of therapy. Clinical outcomes were OS and occurrence of hematologic toxicity of grades 2-5. Associations between the BSI and clinical outcomes were investigated in multivariate regression models including the visual assessment of bone scintigraphy and other relevant covariates. A total of 88 patients were included. The median number of completed RaCl cycles was 4, and 27 patients (31%) completed 6 cycles. The BSI was significantly associated with OS in the multivariate analysis; the median OS for patients with a BSI of greater than 5 was 8.2 mo, and the median OS for patients with a BSI of less than or equal to 5 was 15.0 mo (hazard ratio, 2.65 [95% confidence interval, 1.5-4.71]; = 0.001). Likewise, the baseline BSI was prognostic for the occurrence of hematologic toxicity; patients with a BSI of greater than 5 had an odds ratio of 3.02 (95% confidence interval, 1.2-7.8; = 0.02) for toxicity. The BSI declined during therapy in 44% of the patients who completed 3 cycles of RaCl ( = 52) and in 84% of the patients after the end of therapy ( = 32). There was no significant association between a change in the BSI during therapy and OS. The BSI is a promising biomarker for prognostication of OS and hematologic toxicity in late-stage mCRPC patients receiving RaCl Further prospective studies are needed to evaluate the potential of the BSI for response assessment in RaCl therapy.
本研究旨在探讨在接受放射性氯化镭（RaCl）治疗的晚期转移性去势抵抗性前列腺癌（mCRPC）患者中，骨骼肿瘤负荷的定量评估（骨扫描指数 [BSI]）对预后的预测价值。我们假设 BSI 可以作为总生存期（OS）和血液学毒性的预后生物标志物，并作为 mCRPC 患者接受 RaCl 治疗后反应评估的工具。本研究是对 2014 年 3 月至 2015 年 10 月接受 RaCl 治疗的丹麦 mCRPC 患者队列的回顾性研究，这些患者基线时进行了骨闪烁扫描。对骨闪烁扫描研究进行了回顾和疾病程度分级。此外，还为基线闪烁扫描研究以及治疗结束时的第 3 周期后和第 3 周期后的随访扫描获得了自动 BSI（EXINI Bone）。临床结局为 OS 和 2-5 级血液学毒性的发生。通过包括骨骼闪烁扫描的视觉评估和其他相关协变量的多变量回归模型，研究了 BSI 与临床结局之间的关联。共纳入 88 例患者。完成的 RaCl 周期中位数为 4 个，27 例（31%）完成了 6 个周期。BSI 在多变量分析中与 OS 显著相关；BSI 大于 5 的患者中位 OS 为 8.2 个月，BSI 小于或等于 5 的患者中位 OS 为 15.0 个月（风险比，2.65 [95%置信区间，1.5-4.71]； = 0.001）。同样，基线 BSI 对血液学毒性的发生具有预后意义；BSI 大于 5 的患者毒性的优势比为 3.02（95%置信区间，1.2-7.8； = 0.02）。在完成 3 个 RaCl 周期的 44%（n = 52）患者和治疗结束后的 84%（n = 32）患者中，BSI 在治疗期间下降。BSI 在治疗期间的变化与 OS 之间无显著关联。BSI 是接受 RaCl 治疗的晚期 mCRPC 患者 OS 和血液学毒性预后的有前途的生物标志物。需要进一步的前瞻性研究来评估 BSI 在 RaCl 治疗中反应评估的潜力。
