Wang Zhuonan, Zheng Anqi, Li Yunxuan, Gao Jungang, Dong Weixuan, Li Yan, Duan Xiaoyi
PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Front Oncol. 2022 Aug 26;12:935979. doi: 10.3389/fonc.2022.935979. eCollection 2022.
The prostate-specific membrane antigen (PSMA) PET/CT is potentially identifying patients with oligo-metastasis who would be deemed to only have localized disease in the traditional approaches. However, the best selected oligo-metastasis prostate cancer (PCa) patients most likely to benefit from system androgen deprivation therapy (ADT) are still unknown. The aim of this study was to explore the potential F-PSMA-1007 PET/CT parameters and clinicopathologic characteristics for oligo-metastasis PCa discrimination and follow-up evaluation.
A total of 180 retrospective patients with different metastasis burdens (PCa of none-metastases, oligo-metastases, and poly-metastases), different metastasis status (untreated and recurrent oligo-metastases), and follow-up ADT were included respectively. A one-way analysis of variance was used to evaluate whether PET/CT parameters and clinicopathologic characteristics were different and univariate/multivariate logistic regression models were applied to assess independent predictors in the metastasis burdens group (89/180). Selected predictors were further compared between different metastasis statuses to test the diagnostic accuracy (69/180). The predictor efficiency was evaluated by the ROC and the cut-off value was used to test the ADT response-to-treatment with a longitudinal cohort (22/180) from untreated baseline to 3-15 months.
The significant group differences were observed on SUVmax (P = 0.012), International Society of Urologic Pathologists (ISUP, P<0.001) and Gleason Score (P<0.001). Poly-Metastases patients had higher SUVmax, ISUP and Gleason Score compared to Non-Metastases and Oligo-Metastases patients, respectively (P<0.05, all), and no difference between Non-Metastases and Oligo-Metastases. The SUVmax, ISUP and Gleason Score were independent predictors for metastasis burdens discrimination. The untreated and recurrent oligo-metastases lesions SUVmax were also different (P = 0.036). The AUC of ROC for oligo-metastasis prediction was 0.658 (P = 0.039) when the primary prostatic carcinoma focus SUVmax was higher than 28.22, ADT response-to-treatment patients (5/5 in 22) were all progress in a follow-up test.
The SUVmax can discriminate PCa metastasis degree and oligo-metastasis status. The ADT-treated oligo-metastasis patient may still have disease progression when the primary prostatic carcinoma focus SUVmax is greater than 28.22.
前列腺特异性膜抗原（PSMA）PET/CT有可能识别出在传统方法中被认为仅患有局限性疾病的寡转移患者。然而，最有可能从系统性雄激素剥夺疗法（ADT）中获益的最佳选择的寡转移前列腺癌（PCa）患者仍然未知。本研究的目的是探索潜在的F-PSMA-1007 PET/CT参数以及临床病理特征，用于寡转移PCa的鉴别和随访评估。
分别纳入180例具有不同转移负荷（无转移、寡转移和多转移的PCa）、不同转移状态（未治疗和复发性寡转移）以及接受随访ADT的回顾性患者。采用单因素方差分析来评估PET/CT参数和临床病理特征是否存在差异，并应用单变量/多变量逻辑回归模型来评估转移负荷组（89/180）中的独立预测因素。在不同转移状态之间进一步比较选定的预测因素，以测试诊断准确性（69/180）。通过ROC评估预测因素的效率，并使用临界值来测试来自未治疗基线至3 - 15个月的纵向队列（22/180）中ADT的治疗反应。
在SUVmax（P = 0.012）、国际泌尿病理学会（ISUP，P<0.001）和Gleason评分（P<0.001）方面观察到显著的组间差异。与无转移和寡转移患者相比，多转移患者的SUVmax、ISUP和Gleason评分更高（均P<0.05），无转移和寡转移患者之间无差异。SUVmax、ISUP和Gleason评分是转移负荷鉴别的独立预测因素。未治疗和复发性寡转移病灶的SUVmax也存在差异（P = 0.036）。当原发性前列腺癌灶SUVmax高于28.22时，寡转移预测的ROC曲线下面积为0.658（P = 0.039），ADT治疗反应患者（22例中的5/5）在随访测试中均进展。
SUVmax可区分PCa转移程度和寡转移状态。当原发性前列腺癌灶SUVmax大于28.22时，接受ADT治疗的寡转移患者仍可能出现疾病进展。
