Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany;
Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany.
J Nucl Med. 2023 Aug;64(8):1272-1278. doi: 10.2967/jnumed.122.265379. Epub 2023 Jun 8.
In patients with prostate cancer scheduled for systemic treatment, being overweight is linked to prolonged overall survival (OS), whereas sarcopenia is associated with shorter OS. We investigated fat-related and body composition parameters in patients undergoing prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT) to assess their predictive value for OS. Body mass index (BMI, in kg/m) and CT-derived body composition parameters (total, subcutaneous, visceral fat area, and psoas muscle area at the L3-L4 level) were determined for 171 patients scheduled for PSMA-directed RLT. After normalization for stature, the psoas muscle index was used to define sarcopenia. Outcome analysis was performed using Kaplan-Meier curves and Cox regression including fat-related and other clinical parameters (Gleason score, C-reactive protein [CRP], lactate dehydrogenase [LDH], hemoglobin, and prostate-specific antigen levels). The Harrell C-index was used for goodness-of-fit analysis. Sixty-five patients (38%) had sarcopenia, and 98 patients (57.3%) had increased BMI. Relative to the 8-mo OS in normal-weight men (BMI < 25), overweight men (25 ≥ BMI > 30) and obese men (BMI ≥ 30) achieved a longer OS of 14 mo (hazard ratio [HR], 0.63; 95% CI, 0.40-0.99; = 0.03) and 13 mo (HR, 0.47; 95% CI, 0.29-0.77; = 0.004), respectively. Sarcopenia showed no impact on OS (11 vs. 12 mo; HR, 1.4; 95% CI, 0.91-2.1; = 0.09). Most of the body composition parameters were tightly linked to OS on univariable analyses, with the highest C-index for BMI. In multivariable analysis, a higher BMI (HR, 0.91; 95% CI, 0.86-0.97; = 0.006), lower CRP (HR, 1.09; 95% CI, 1.03-1.14; < 0.001), lower LDH (HR, 1.08; 95% CI, 1.03-1.14; < 0.001), and longer interval between initial diagnosis and RLT (HR, 0.95; 95% CI, 0.91-0.99; = 0.02) were significant predictors of OS. Increased fat reserves assessed by BMI, CRP, LDH, and interval between initial diagnosis and RLT, but not CT-derived body composition parameters, were relevant predictors for OS. As BMI can be altered, future research should investigate whether a high-calorie diet before or during PSMA RLT may improve OS.
在计划接受全身治疗的前列腺癌患者中，超重与总生存期（OS）延长有关，而肌肉减少症与 OS 缩短有关。我们研究了接受前列腺特异性膜抗原（PSMA）定向放射性配体治疗（RLT）的患者的脂肪相关和身体成分参数，以评估其对 OS 的预测价值。为 171 名计划接受 PSMA 定向 RLT 的患者确定了身体质量指数（BMI，以 kg/m 为单位）和 CT 衍生的身体成分参数（总脂肪面积、皮下脂肪面积、内脏脂肪面积和 L3-L4 水平的腰大肌面积）。在标准化身高后，使用腰大肌指数来定义肌肉减少症。使用 Kaplan-Meier 曲线和 Cox 回归（包括脂肪相关和其他临床参数（Gleason 评分、C 反应蛋白[CRP]、乳酸脱氢酶[LDH]、血红蛋白和前列腺特异性抗原水平）进行生存分析。哈雷尔 C 指数用于拟合优度分析。65 名患者（38%）存在肌肉减少症，98 名患者（57.3%）BMI 增加。与体重正常男性（BMI<25）的 8 个月 OS 相比，超重男性（25≥BMI>30）和肥胖男性（BMI≥30）的 OS 延长至 14 个月（风险比[HR]，0.63；95%CI，0.40-0.99； = 0.03）和 13 个月（HR，0.47；95%CI，0.29-0.77； = 0.004）。肌肉减少症对 OS 没有影响（11 个月 vs. 12 个月；HR，1.4；95%CI，0.91-2.1； = 0.09）。大多数身体成分参数在单变量分析中与 OS 密切相关，BMI 的 C 指数最高。在多变量分析中，较高的 BMI（HR，0.91；95%CI，0.86-0.97； = 0.006）、较低的 CRP（HR，1.09；95%CI，1.03-1.14；<0.001）、较低的 LDH（HR，1.08；95%CI，1.03-1.14；<0.001）和初始诊断与 RLT 之间的间隔时间较长（HR，0.95；95%CI，0.91-0.99； = 0.02）是 OS 的显著预测因素。BMI、CRP、LDH 和初始诊断与 RLT 之间的间隔时间评估的脂肪储备增加是 OS 的相关预测因素，但 CT 衍生的身体成分参数不是。由于 BMI 可以改变，因此未来的研究应该调查在 PSMA RLT 之前或期间是否高卡路里饮食可以提高 OS。
