Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and.
J Nucl Med. 2021 Aug 1;62(8):1050-1056. doi: 10.2967/jnumed.120.256602. Epub 2021 Jan 8.
New biomarkers for metastatic prostate cancer are needed. The aim of this study was to evaluate the prognostic value of F-FDG PET whole-body tumor burden parameters in patients with metastatic prostate cancer who received first-line abiraterone or enzalutamide therapy. This was a retrospective study of patients with metastatic castration-sensitive prostate cancer (mCSPC, = 25) and metastatic castration-resistant prostate cancer (mCRPC, = 71) who underwent F-FDG PET/CT within 90 d before first-line treatment with abiraterone or enzalutamide at a tertiary-care academic cancer center. Whole-body tumor burden on PET/CT was quantified as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and correlated with overall survival (OS) probabilities using Kaplan-Meier curves and Cox models. The median follow-up in survivors was 56.3 mo (interquartile range, 37.7-66.8 mo); the median OSs for patients with mCRPC and mCSPC were 27.8 and 76.1 mo, respectively ( < 0.001). On univariate analysis, the OS probability of mCRPC patients was significantly associated with plasma levels of alkaline phosphatase (hazard ratio [HR], 1.90; < 0.001), plasma levels of lactate dehydrogenase (HR, 1.01; < 0.001), hemoglobin levels (HR, 0.80; = 0.013), whole-body SUV (HR, 1.14; < 0.001), the number of F-FDG-avid metastases (HR, 1.08; < 0.001), whole-body metabolic tumor volume (HR, 1.86; < 0.001), and TLG (HR, 1.84; < 0.001). On multivariable analysis with stepwise variable selection, hemoglobin levels (HR, 0.81; = 0.013) and whole-body TLG (HR, 1.88; < 0.001) were independently associated with OS. In mCSPC patients, no significant association was observed between these variables and OS. In patients with mCRPC receiving first-line treatment with abiraterone or enzalutamide, F-FDG PET WB TLG is independently associated with OS and might be used as a quantitative prognostic imaging biomarker.
需要新的转移性前列腺癌生物标志物。本研究旨在评估氟代脱氧葡萄糖正电子发射断层扫描（F-FDG PET）全身肿瘤负荷参数在接受一线阿比特龙或恩扎鲁胺治疗的转移性前列腺癌患者中的预后价值。这是一项回顾性研究，纳入了在三级学术癌症中心接受一线阿比特龙或恩扎鲁胺治疗前 90 天内接受 F-FDG PET/CT 检查的转移性去势敏感前列腺癌（mCSPC，n = 25）和转移性去势抵抗性前列腺癌（mCRPC，n = 71）患者。PET/CT 上的全身肿瘤负荷用代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）来量化，并使用 Kaplan-Meier 曲线和 Cox 模型与总生存（OS）概率相关联。在幸存者中，中位随访时间为 56.3 个月（四分位间距，37.7-66.8 个月）；mCRPC 和 mCSPC 患者的中位 OS 分别为 27.8 和 76.1 个月（<0.001）。单因素分析显示，mCRPC 患者的 OS 概率与血浆碱性磷酸酶水平（风险比 [HR]，1.90；<0.001）、血浆乳酸脱氢酶水平（HR，1.01；<0.001）、血红蛋白水平（HR，0.80；=0.013）、全身 SUV（HR，1.14；<0.001）、F-FDG 阳性转移灶的数量（HR，1.08；<0.001）、全身代谢肿瘤体积（HR，1.86；<0.001）和 TLG（HR，1.84；<0.001）显著相关。多因素分析采用逐步变量选择，血红蛋白水平（HR，0.81；=0.013）和全身 TLG（HR，1.88；<0.001）与 OS 独立相关。在 mCSPC 患者中，这些变量与 OS 之间未观察到显著相关性。在接受一线阿比特龙或恩扎鲁胺治疗的 mCRPC 患者中，F-FDG PET 全身 TLG 与 OS 独立相关，可能作为一种定量预后成像生物标志物。
