Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Prostate. 2022 Jan;82(1):41-48. doi: 10.1002/pros.24246. Epub 2021 Oct 11.
We sought to assess the prognostic utility of 11C-choline positron emission tomography/computed tomography (PET/CT) in patients with metastatic castrate resistant prostate cancer (mCRPC) undergoing primary docetaxel chemotherapy.
We performed a single institution retrospective analysis of 77 mCRPC patients who were treated with 6 cycles of docetaxel chemotherapy, and who also underwent 11C-choline PET/CT scans at baseline (before chemotherapy), mid-course (after 3 cycles), and posttherapy (after 6 cycles). We evaluated treatment response based on percent change in blood pool-corrected maximum standardized uptake value (SUVmax) of the target lesion on PET/CT, as well as percent change in serum prostate specific antigen (PSA). Logistic regression analysis was used to identify factors associated with complete treatment response. Progression free survival (PFS) analysis was performed using log-rank test and shown on Kaplan-Meier plot.
Percent change in blood pool-corrected SUVmax on mid-course scan was a significant predictor of complete response (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.96-0.99, p = .0003), whereas percent change in PSA was not (OR: 0.99, 95% CI: 0.99-1.01, p = .6025). 57 of 77 patients (74%) achieved ≥20% reduction in blood pool-corrected SUVmax on mid-course; these patients were 3.6 times more likely to achieve complete response after full 6 cycles of docetaxel chemotherapy, compared to patients with <20% reduction in blood pool-corrected SUVmax (OR: 3.56, 95% CI: 1.04-16.52, p = .0420). Median PFS in the complete response group was 35.1 months (95% CI: 26.0-52.7 months), compared to 9.4 months (95% CI: 6.9-13.0 months) in the incomplete response group (p = .0005).
Our study showed that mid-course and posttherapy 11C-choline PET/CT evaluation for mCRPC patients undergoing primary docetaxel chemotherapy can predict full course treatment response and PFS, respectively. 11C-choline PET/CT imaging may provide valuable prognostic information to guide treatment choices for patients with mCRPC.
我们旨在评估 11C-胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）在接受初始多西他赛化疗的转移性去势抵抗性前列腺癌（mCRPC）患者中的预后价值。
我们对 77 例接受 6 个周期多西他赛化疗且基线（化疗前）、中期（第 3 个周期后）和治疗后（第 6 个周期后）均行 11C-胆碱 PET/CT 扫描的 mCRPC 患者进行了单机构回顾性分析。我们根据 PET/CT 上目标病变血池校正最大标准化摄取值（SUVmax）的变化百分比以及血清前列腺特异性抗原（PSA）的变化百分比来评估治疗反应。使用逻辑回归分析确定与完全治疗反应相关的因素。使用对数秩检验进行无进展生存期（PFS）分析，并在 Kaplan-Meier 图上显示。
中期扫描的血池校正 SUVmax 的变化百分比是完全缓解的显著预测因子（比值比[OR]：0.98，95%置信区间[CI]：0.96-0.99，p=0.0003），而 PSA 的变化百分比则不是（OR：0.99，95% CI：0.99-1.01，p=0.6025）。77 例患者中有 57 例（74%）在中期达到血池校正 SUVmax 降低≥20%；与血池校正 SUVmax 降低<20%的患者相比，这些患者在接受完整 6 个周期多西他赛化疗后完全缓解的可能性高 3.6 倍（OR：3.56，95% CI：1.04-16.52，p=0.0420）。完全缓解组的中位 PFS 为 35.1 个月（95% CI：26.0-52.7 个月），而不完全缓解组为 9.4 个月（95% CI：6.9-13.0 个月）（p=0.0005）。
我们的研究表明，mCRPC 患者接受初始多西他赛化疗时，中期和治疗后 11C-胆碱 PET/CT 评估可分别预测全程治疗反应和 PFS。11C-胆碱 PET/CT 成像可能为 mCRPC 患者的治疗选择提供有价值的预后信息。
