Franzese C, Lucchini R, Roghi M, Badalamenti M, Baldaccini D, Comito T, Franceschini D, Navarria P, Di Cristina L, Lo Faro L, Galdieri C, Reggiori G, Mancosu P, Tomatis S, Scorsetti M
Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy.
IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy.
Clin Oncol (R Coll Radiol). 2023 Dec;35(12):e649-e656. doi: 10.1016/j.clon.2023.09.004. Epub 2023 Sep 16.
The definition of oligometastatic prostate cancer (OPCa) is currently based solely on the maximum number of detectable metastases, as there are no validated biomarkers available. The aim of this study was to identify novel predictive factors for OPCa patients who underwent metastases-directed therapy.
This monocentre, retrospective study included consecutive OPCa patients with a maximum of five metastases in up to two organs, detected with choline- or PSMA-positron emission tomography, who were treated with metastases-directed stereotactic body radiation therapy. Endpoints were overall survival and progression-free survival, assessed with Kaplan-Meier analysis. Univariate and multivariable Cox regression was carried out to evaluate the association between clinical factors and survival outcomes.
Between 2009 and 2021, 163 patients and 320 metastases were treated with 226 stereotactic body radiation therapy courses. The median three-dimensional metastatic tumour volume was 4.1 cm, with a range from 0.01 to 233.4 cm. In total, 87 (53.4%), 21 (12.9%) and 55 (33.7%) metastases were classified as cN1, cM1a and cM1b, respectively. The median follow-up was 28.5 months. The rates of overall survival at 1, 3 and 5 years were 89.5% (95% confidence interval 83.4-93.4), 74.9% (95% confidence interval 66.1-81.7) and 57.2% (95% confidence interval 45.8-67.1), respectively. Multivariable analysis showed that overall survival reduced with the increase in three-dimensional total tumour volume (hazard ratio 1.93, 95% confidence interval 1.06-3.52; P = 0.030) and confirmed a significant difference between cN1 versus cM1a-b disease (hazard ratio 1.81, 95% confidence interval 1.01-3.25; P = 0.046). The cut-off value of total volume correlated with the highest risk of death was 20 cm (hazard ratio 2.37, 95% confidence interval 1.34-4.18; P = 0.003). The median progression-free survival was 17.8 months, with 1-, 3- and 5-year rates of 63.7% (95% confidence interval 55.4-70.9), 31.5% (95% confidence interval 22.8-40.6) and 24.7% (95% confidence interval 16.0-34.3).
This study identified three-dimensional total tumour volume and the site of oligometastases as significant predictors of survival in OPCa patients treated with metastases-directed therapy. These parameters can potentially be used to personalised treatment and improve patient outcome.
由于目前尚无经过验证的生物标志物，寡转移性前列腺癌（OPCa）的定义仅基于可检测到的转移灶的最大数量。本研究的目的是为接受转移灶定向治疗的OPCa患者确定新的预测因素。
本单中心回顾性研究纳入了连续的OPCa患者，这些患者通过胆碱或PSMA正电子发射断层扫描检测到在最多两个器官中存在最多五个转移灶，并接受了转移灶定向立体定向体部放射治疗。终点指标为总生存期和无进展生存期，采用Kaplan-Meier分析进行评估。进行单变量和多变量Cox回归以评估临床因素与生存结果之间的关联。
2009年至2021年期间，163例患者和320个转移灶接受了226个立体定向体部放射治疗疗程。三维转移瘤体积中位数为4.1 cm，范围为0.01至233.4 cm。总共有87个（53.4%）、21个（12.9%）和55个（33.7%）转移灶分别被分类为cN1、cM1a和cM1b。中位随访时间为28.5个月。1年、3年和5年的总生存率分别为89.5%（95%置信区间83.4 - 93.4）、74.9%（95%置信区间66.1 - 81.7）和57.2%（95%置信区间45.8 - 67.1）。多变量分析显示，总生存期随着三维肿瘤总体积的增加而降低（风险比1.93，95%置信区间1.06 - 3.52；P = 0.030），并证实cN1与cM1a - b疾病之间存在显著差异（风险比1.81，95%置信区间1.01 - 3.25；P = 0.046）。与死亡风险最高相关的总体积临界值为20 cm（风险比2.37，95%置信区间1.34 - 4.18；P = 0.003）。中位无进展生存期为17.8个月，1年、3年和5年的发生率分别为63.7%（95%置信区间55.4 - 70.9）、31.5%（95%置信区间22.8 - 40.6）和24.7%（95%置信区间16.0 - 34.3）。
本研究确定三维肿瘤总体积和寡转移灶部位是接受转移灶定向治疗的OPCa患者生存的重要预测因素。这些参数有可能用于个性化治疗并改善患者预后。
