Vogel Marco M E, Kroeze Stephanie G C, Henkenberens Christoph, Schmidt-Hegemann Nina-Sophie, Kirste Simon, Becker Jessica, Burger Irene A, Derlin Thorsten, Bartenstein Peter, Mix Michael, la Fougère Christian, Eiber Matthias, Christiansen Hans, Belka Claus, Grosu Anca L, Müller Arndt-Christian, Guckenberger Matthias, Combs Stephanie E
Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany.
Department of Radiation Sciences (DRS), Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.
Eur J Nucl Med Mol Imaging. 2020 Sep;47(10):2328-2338. doi: 10.1007/s00259-020-04760-8. Epub 2020 Mar 16.
Since the success of prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging for patients with oligorecurrent prostate cancer (ORPC), it is increasingly used for radiotherapy as metastasis-directed therapy (MDT). Therefore, we developed a prognostic risk classification for biochemical relapse-free survival (bRFS) for patients after PSMA-PET-guided MDT after radical prostatectomy.
We analyzed 292 patients with local recurrence (LR) and/or pelvic lymph node (LN) lesions and/or up to five distant LN, bone (BM), or visceral metastases (VM) detected with [Ga]PSMA-PET imaging. Median follow-up was 16 months (range 0-57). The primary endpoint was bRFS after MDT. Cox regression analysis for risk factors was incorporated into a recursive partitioning analysis (RPA) with classification and regression tree method.
PSA at recurrence ≥ 0.8 ng/mL, BM, and VM was significantly associated with biochemical relapse. RPA showed five groups with tenfold cross-validation of 0.294 (SE 0.032). After building risk classes I to IV (p < 0.0001), mean bRFS was 36.3 months (95% CI 32.4-40.1) in class I (PSA < 0.8 ng/mL, no BM) and 25.8 months (95% CI 22.5-29.1) in class II (PSA ≥ 0.8 ng/mL, no BM, no VM). LR and/or pelvic LNs caused relapse in classes I and II. Mean bRFS was 16.0 months (95% CI 12.4-19.6) in class III (PSA irrelevant, present BM) and 5.7 months (95% CI 2.7-8.7) in class IV (PSA ≥ 0.8 ng/mL, no BM, present VM).
We developed and internally validated a risk classification for bRFS after PSMA-PET-guided MDT. Patients with PSA < 0.8 ng/mL and local relapse only (LR and/or pelvic LNs) had the most promising bRFS. PSA ≥ 0.8 ng/mL and local relapse only (LR and/or pelvic LNs) indicated intermediate risk for failure. Patients with BM were at higher risk regardless of the PSA. However, those patients still show satisfactory bRFS. In patients with VM, bRFS is heavily decreased. MDT in such cases should be discussed individually.
鉴于前列腺特异性膜抗原正电子发射断层扫描（PSMA-PET）成像在寡复发前列腺癌（ORPC）患者中的成功应用，其越来越多地被用作转移导向治疗（MDT）的放射治疗。因此，我们针对根治性前列腺切除术后接受PSMA-PET引导的MDT的患者，制定了生化无复发生存期（bRFS）的预后风险分类。
我们分析了292例经[Ga]PSMA-PET成像检测出局部复发（LR）和/或盆腔淋巴结（LN）病变和/或多达五个远处LN、骨（BM）或内脏转移（VM）的患者。中位随访时间为16个月（范围0-57个月）。主要终点是MDT后的bRFS。将风险因素的Cox回归分析纳入采用分类与回归树方法的递归划分分析（RPA）。
复发时前列腺特异性抗原（PSA）≥0.8 ng/mL、BM和VM与生化复发显著相关。RPA显示五组，十折交叉验证值为0.294（标准误0.032）。在建立I至IV类风险分级后（p<0.0001），I类（PSA<0.8 ng/mL，无BM）的平均bRFS为36.3个月（95%置信区间32.4-40.1），II类（PSA≥0.8 ng/mL，无BM，无VM）为25.8个月（95%置信区间22.5-29.1）。I类和II类中LR和/或盆腔LN导致复发。III类（PSA无关，存在BM）的平均bRFS为16.0个月（95%置信区间12.4-19.6），IV类（PSA≥0.8 ng/mL，无BM，存在VM）为5.7个月（95%置信区间2.7-8.7）。
我们制定并内部验证了PSMA-PET引导的MDT后bRFS的风险分类。PSA<0.8 ng/mL且仅局部复发（LR和/或盆腔LN）的患者bRFS最有前景。PSA≥0.8 ng/mL且仅局部复发（LR和/或盆腔LN）表明失败风险中等。无论PSA如何情况，有BM的患者风险更高。然而，这些患者的bRFS仍令人满意。有VM患者的bRFS大幅降低。此类情况下的MDT应个体化讨论。
