Nuclear Medicine Department, University General Hospital, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain.
Departamento de Matemáticas, Universidad de Castilla La Mancha, Ciudad Real, Spain.
Clin Transl Oncol. 2019 Mar;21(3):289-297. doi: 10.1007/s12094-018-1920-6. Epub 2018 Jul 13.
To establish the utility of baseline F-Fluorocholine (FCH) PET/CT and bone scintigraphy (BS) in the outcome prediction of patients with castration-resistant prostate cancer and bone metastases (CRPC-BM) treated with Ra.
Prospective, multicenter and non-randomized study (ChoPET-Rad study). FCH PET/CT and BS were performed before the initiation of Ra (basal FCH PET/CT and BS). Bone disease was classified attending the number of lesions in baseline BS and PET/CT. FCH PET/CT was semiquantitatively evaluated. Gleason score, baseline levels of prostate-specific antigen (PSA), alkaline phosphatase and lactate dehydrogenase were determined. Progression-free survival (PFS) and overall survival (OS) since the onset of Ra treatment was calculated. PFS was defined by PSA rising. Relations between clinical and imaging variables with PFS and OS were evaluated by Pearson, Mann-Whitney tests and Kapplan-Meier analysis. Univariate and multivariate Cox regression analysis was performed.
Forty patients were evaluated. The median PFS and OS were of 3.0 ± 2.3 and 23.0 ± 4.2 months, respectively. 33 patients progressed and 13 died during the follow-up. The extension of the bone disease by FCH PET/CT (p = 0.011, χ = 10.63), BS (p = 0.044, χ = 8.04), SUVmax (p = 0.012) and average SUVmax (p = 0.014) were related to OS. No significant association was found for the PFS. ROC analysis revealed significant association of SUVmax, average SUVmax and basal PSA with OS. Only therapeutic failure was associated with OS in the multivariate analysis (HR = 3.6, p = 0.04).
FCH PET/CT and BS had prognostic aim in the prediction of OS. None clinical or imaging variable was able to predict the PFS, probably due to the high rate of progressive disease.
评估基线 F-氟代胆碱（FCH）正电子发射断层扫描/计算机断层扫描（PET/CT）和骨闪烁扫描（BS）在接受镭-223 治疗的去势抵抗性前列腺癌伴骨转移（CRPC-BM）患者中的预后预测价值。
前瞻性、多中心、非随机研究（ChoPET-Rad 研究）。在接受镭-223 治疗前（基础 FCH PET/CT 和 BS）进行 FCH PET/CT 和 BS。根据基线 BS 和 PET/CT 中病变数量对骨病进行分类。对 FCH PET/CT 进行半定量评估。测定前列腺特异性抗原（PSA）、碱性磷酸酶和乳酸脱氢酶的基线水平，计算格拉斯哥评分。自接受镭-223 治疗开始，计算无进展生存期（PFS）和总生存期（OS）。PFS 定义为 PSA 升高。采用 Pearson、Mann-Whitney 检验和 Kapplan-Meier 分析评估临床和影像学变量与 PFS 和 OS 的关系。进行单变量和多变量 Cox 回归分析。
共评估了 40 例患者。中位 PFS 和 OS 分别为 3.0±2.3 个月和 23.0±4.2 个月。随访期间 33 例患者进展，13 例患者死亡。FCH PET/CT（p=0.011，χ²=10.63）、BS（p=0.044，χ²=8.04）、SUVmax（p=0.012）和平均 SUVmax（p=0.014）的骨病扩展与 OS 相关。PFS 与任何临床变量均无显著相关性。ROC 分析显示 SUVmax、平均 SUVmax 和基础 PSA 与 OS 显著相关。仅治疗失败与 OS 相关（HR=3.6，p=0.04）。
FCH PET/CT 和 BS 在预测 OS 方面具有预后价值。没有任何临床或影像学变量能够预测 PFS，这可能是由于疾病进展率较高所致。
