Kitajima Kazuhiro, Kuyama Junpei, Kawahara Takashi, Suga Tsuyoshi, Otani Tomoaki, Sugawara Shigeyasu, Kono Yumiko, Tamaki Yukihisa, Seko-Nitta Ayumi, Ishiwata Yoshinobu, Ito Kimiteru, Toriihara Akira, Watanabe Shiro, Hosono Makoto, Miyake Hideaki, Yamamoto Shingo, Sasaki Ryohei, Narita Mitsuhiro, Yamakado Koichiro
Department of Radiology, Hyogo Medical University, Hyogo 663-8131, Japan.
Nuclear Medicine, Chiba Cancer Center, Chiba 260-8717, Japan.
Cancers (Basel). 2023 May 16;15(10):2784. doi: 10.3390/cancers15102784.
To evaluate the usefulness of change in the automated bone scan index (aBSI) value derived from bone scintigraphy findings as an imaging biomarker for the assessment of treatment response and survival prediction in metastatic castration-resistant prostate cancer (mCRPC) patients treated with Ra-223. This study was a retrospective investigation of a Japanese cohort of 205 mCRPC patients who received Ra-223 in 14 hospitals between July 2016 and August 2020 and for whom bone scintigraphy before and after radium-223 treatment was available. Correlations of aBSI change, with changes in the serum markers alkaline phosphatase (ALP) and prostate-specific antigen (PSA) were evaluated. Additionally, the association of those changes with overall survival (OS) was assessed using the Cox proportional-hazards model and Kaplan-Meier curve results. Of the 205 patients enrolled, 165 (80.5%) completed six cycles of Ra-223. Following treatment, ALP decline (%ALP < 0%) was noted in 72.2% (148/205), aBSI decline (%aBSI < 0%) in 52.7% (108/205), and PSA decline (%PSA < 0%) in 27.8% (57/205). Furthermore, a reduction in both aBSI and ALP was seen in 87 (42.4%), a reduction in only ALP was seen in 61 (29.8%), a reduction in only aBSI was seen in 21 (10.2%), and in both aBSI and ALP increasing/stable (≥0%) was seen in 36 (17.6%) patients. Multiparametric analysis showed changes in PSA [hazard ratio (HR) 4.30, 95% confidence interval (CI) 2.32-8.77, < 0.0001], aBSI (HR 2.22, 95%CI 1.43-3.59, = 0.0003), and ALP (HR 2.06, 95%CI 1.35-3.14, = 0.0008) as significant prognostic factors for OS. For mCRPC patients treated with Ra-223, aBSI change is useful as an imaging biomarker for treatment response assessment and survival prediction.
为评估从骨闪烁显像结果得出的自动骨扫描指数（aBSI）值的变化，作为一种成像生物标志物，用于评估接受Ra-223治疗的转移性去势抵抗性前列腺癌（mCRPC）患者的治疗反应和生存预测。本研究是一项对日本队列中205例mCRPC患者的回顾性调查，这些患者于2016年7月至2020年8月期间在14家医院接受了Ra-223治疗，且有镭-223治疗前后的骨闪烁显像资料。评估了aBSI变化与血清标志物碱性磷酸酶（ALP）和前列腺特异性抗原（PSA）变化的相关性。此外，使用Cox比例风险模型和Kaplan-Meier曲线结果评估了这些变化与总生存期（OS）的关联。在纳入的205例患者中，165例（80.5%）完成了六个周期的Ra-223治疗。治疗后，72.2%（148/205）的患者出现ALP下降（%ALP < 0%），52.7%（108/205）的患者出现aBSI下降（%aBSI < 0%），27.8%（57/205）的患者出现PSA下降（%PSA < 0%）。此外，87例（42.4%）患者的aBSI和ALP均降低，61例（29.8%）患者仅ALP降低，21例（10.2%）患者仅aBSI降低，36例（17.6%）患者的aBSI和ALP均升高/稳定（≥0%）。多参数分析显示，PSA变化[风险比（HR）4.30，95%置信区间（CI）2.32 - 8.77，P < 0.0001]、aBSI变化（HR 2.22，95%CI 1.43 - 3.59，P = 0.0003）和ALP变化（HR 2.06，95%CI 1.35 - 3.14，P = 0.0008）是OS的显著预后因素。对于接受Ra-223治疗的mCRPC患者，aBSI变化作为治疗反应评估和生存预测的成像生物标志物是有用的。
