Lu-Dotatate 肽受体放射性核素治疗（PRRT）在进展性高分化神经内分泌肿瘤（NETS）患者中的生存预测因素。
Survival predictors of Lu-Dotatate peptide receptor radionuclide therapy (PRRT) in patients with progressive well-differentiated neuroendocrine tumors (NETS).
机构信息
Medical Imaging Department, Division of Nuclear Medicine, Victoria Hospital, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, PO Box 5010, London, ON, N6A 5W9, Canada.
Medical Imaging Department, Division of Diagnostic Radiology, University of Western Ontario, London, ON, Canada.
出版信息
J Cancer Res Clin Oncol. 2022 Jan;148(1):225-236. doi: 10.1007/s00432-021-03672-w. Epub 2021 Jun 10.
PURPOSE
Lu-Dotatate is an emerging treatment modality for patients with unresectable or metastatic well-differentiated NETs. This study examines survival predictors in patients who received Lu-Dotatate.
METHODS
A retrospective single-center review was conducted, examining 47 individuals with progressive well-differentiated NETs treated with Lu-Dotatate (four induction cycles of 5.5 GBq at 10-week intervals followed by eight maintenance cycles of 3.7 GBq at 6-month intervals).
RESULTS
Median follow-up was 63.1 months with a median progression-free survival (PFS) of 34.1 months. However, median overall survival (OS) was not reached at the time of analysis. The presence of ≥ 5 bone metastases (hazard ratio HR 4.33; p = 0.015), non-gastroenteropancreatic (non-GEP) NETs (HR 3.22; p = 0.025) and development of interim ascites (HR 3.15; p = 0.047) independently predicted a worse OS. Patients with chromogranin A of ≥ 4 × upper limit of normal (ULN) had shorter OS (p < 0.001) and PFS (p = 0.004). Similarly, those with pre-existing ascites demonstrated a worse OS (p = 0.009) and PFS (p = 0.026). Liver metastases involving greater than 50% liver volume and the existence of unusual metastatic locations had a negative impact on OS (p = 0.033) and PFS (p = 0.026), respectively.
CONCLUSION
High burden of skeletal and hepatic metastases, non-GEP-NETs, chromogranin A of ≥ 4 × ULN, unusual metastatic sites, pre-existing and interim ascites are predictors of poor outcomes in patients treated with Lu-Dotatate. These common indicators can be used for the risk stratification and identification of patients most likely to benefit from PRRT.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT02236910, Retrospectively registered on September, 2014.
目的
Lu-Dotatate 是一种新兴的治疗不可切除或转移性分化良好的神经内分泌肿瘤（NET）的方法。本研究旨在探讨接受 Lu-Dotatate 治疗的患者的生存预测因素。
方法
进行了一项回顾性单中心研究，共纳入 47 例接受 Lu-Dotatate 治疗的进展性分化良好的 NET 患者（每 10 周进行 4 个诱导周期，每个周期给予 5.5GBq；随后每 6 个月进行 8 个维持周期，每个周期给予 3.7GBq）。
结果
中位随访时间为 63.1 个月，中位无进展生存期（PFS）为 34.1 个月。然而，在分析时，中位总生存期（OS）尚未达到。存在≥5 处骨转移（风险比 HR 4.33；p=0.015）、非胃肠胰腺（non-GEP）NET（HR 3.22；p=0.025）和治疗期间出现腹水（HR 3.15；p=0.047）是 OS 较差的独立预测因素。嗜铬粒蛋白 A（CgA）≥4×正常值上限（ULN）的患者 OS（p<0.001）和 PFS（p=0.004）更短。同样，存在腹水的患者 OS（p=0.009）和 PFS（p=0.026）更差。肝转移累及超过 50%的肝体积以及存在不常见的转移部位对 OS（p=0.033）和 PFS（p=0.026）有负面影响。
结论
骨骼和肝脏转移负担高、非 GEP-NET、CgA≥4×ULN、不常见的转移部位、治疗前和治疗期间存在腹水是接受 Lu-Dotatate 治疗的患者预后不良的预测因素。这些常见指标可用于风险分层和识别最有可能从 PRRT 中获益的患者。
试验注册
ClinicalTrials.gov 标识符：NCT02236910，于 2014 年 9 月回顾性注册。
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