Sollini Martina, Bartoli Francesco, Cavinato Lara, Ieva Francesca, Ragni Alessandra, Marciano Andrea, Zanca Roberta, Galli Luca, Paiar Fabiola, Pasqualetti Francesco, Erba Paola Anna
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy.
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
EJNMMI Res. 2021 Nov 27;11(1):119. doi: 10.1186/s13550-021-00858-8.
The role of image-derived biomarkers in recurrent oligometastatic Prostate Cancer (PCa) is unexplored. This paper aimed to evaluate [F]FMCH PET/CT radiomic analysis in patients with recurrent PCa after primary radical therapy. Specifically, we tested intra-patient lesions similarity in oligometastatic and plurimetastatic PCa, comparing the two most used definitions of oligometastatic disease.
PCa patients eligible for [F]FMCH PET/CT presenting biochemical failure after first-line curative treatments were invited to participate in this prospective observational trial. PET/CT images of 92 patients were visually and quantitatively analyzed. Each patient was classified as oligometastatic or plurimetastatic according to the total number of detected lesions (up to 3 and up to 5 or > 3 and > 5, respectively). Univariate and intra-patient lesions' similarity analysis were performed.
[F]FMCH PET/CT identified 370 lesions, anatomically classified as regional lymph nodes and distant metastases. Thirty-eight and 54 patients were designed oligometastatic and plurimetastatic, respectively, using a 3-lesion threshold. The number of oligometastic scaled up to 60 patients (thus 32 plurimetastatic patients) with a 5-lesion threshold. Similarity analysis showed high lesions' heterogeneity. Grouping patients according to the number of metastases, patients with oligometastatic PCa defined with a 5-lesion threshold presented lesions heterogeneity comparable to plurimetastic patients. Lesions within patients having a limited tumor burden as defined by three lesions were characterized by less heterogeneity.
We found a comparable heterogeneity between patients with up to five lesions and plurimetastic patients, while patients with up to three lesions were less heterogeneous than plurimetastatic patients, featuring different cells phenotypes in the two groups. Our results supported the use of a 3-lesion threshold to define oligometastatic PCa.
影像衍生生物标志物在复发性寡转移前列腺癌（PCa）中的作用尚未得到探索。本文旨在评估[F]FMCH PET/CT放射组学分析在原发性根治性治疗后复发性PCa患者中的应用。具体而言，我们测试了寡转移和多转移PCa患者体内病变的相似性，比较了两种最常用的寡转移疾病定义。
邀请一线根治性治疗后出现生化失败且符合[F]FMCH PET/CT检查条件的PCa患者参加这项前瞻性观察性试验。对92例患者的PET/CT图像进行了视觉和定量分析。根据检测到的病变总数（分别最多为3个和最多为5个或>3个和>5个）将每位患者分类为寡转移或多转移。进行了单变量和患者体内病变相似性分析。
[F]FMCH PET/CT识别出370个病变，解剖学上分类为区域淋巴结和远处转移。使用3个病变阈值时，分别有38例和54例患者被定义为寡转移和多转移。使用5个病变阈值时，寡转移患者数量增至60例（因此多转移患者为32例）。相似性分析显示病变具有高度异质性。根据转移灶数量对患者进行分组，使用5个病变阈值定义的寡转移PCa患者的病变异质性与多转移患者相当。由3个病变定义的肿瘤负荷有限的患者体内的病变异质性较小。
我们发现，病变数最多为5个的患者与多转移患者之间存在相当的异质性，而病变数最多为3个的患者比多转移患者的异质性小，两组具有不同的细胞表型。我们的结果支持使用3个病变阈值来定义寡转移PCa。
