Wetz Christoph, Ruhwedel Tristan, Schatka Imke, Grabowski Jane, Jann Henning, Metzger Giulia, Galler Markus, Amthauer Holger, Rogasch Julian M M
Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
Cancers (Basel). 2023 Dec 6;15(24):5717. doi: 10.3390/cancers15245717.
Pretherapeutic chromogranin A, alkaline phosphatase (ALP), or De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) are prognostic factors in patients with metastatic neuroendocrine tumors (NET) undergoing peptide receptor radionuclide therapy (PRRT). However, their value for intratherapeutic monitoring remains unclear. We evaluated if changes in plasma markers during PRRT can help identify patients with unfavorable outcomes.
A monocentric retrospective analysis of 141 patients with NET undergoing PRRT with [Lu]Lu-DOTATOC was conducted. Changes in laboratory parameters were calculated by dividing the values determined immediately before each cycle of PRRT by the pretherapeutic value. Patients with low vs. high PFS were compared with the Wilcoxon rank-sum test.
Progression, relapse, or death after PRRT was observed in 103/141 patients. Patients with low PFS showed a significant relative ALP increase before the third ( = 0.014) and fourth ( = 0.039) cycles of PRRT. Kaplan-Meier analysis revealed a median PFS of 24.3 months (95% CI, 20.7-27.8 months) in patients with decreasing ALP values (Δ > 10%) during treatment, 12.5 months (95% CI, 9.2-15.8 months) in patients with increasing ALP values (Δ > 10%), and 17.7 months (95% CI, 13.6-21.8 months) with stable ALP values (Δ ± 10%).
Based on these exploratory data, a rise in plasma ALP might indicate disease progression and should be interpreted cautiously during therapy.
治疗前嗜铬粒蛋白A、碱性磷酸酶（ALP）或德瑞蒂斯比值（天冬氨酸转氨酶/丙氨酸转氨酶）是接受肽受体放射性核素治疗（PRRT）的转移性神经内分泌肿瘤（NET）患者的预后因素。然而，它们在治疗期间监测的价值仍不明确。我们评估了PRRT期间血浆标志物的变化是否有助于识别预后不良的患者。
对141例接受[Lu]Lu-DOTATOC PRRT的NET患者进行单中心回顾性分析。通过将PRRT每个周期前立即测定的值除以治疗前值来计算实验室参数的变化。采用Wilcoxon秩和检验比较低PFS与高PFS患者。
141例患者中有103例在PRRT后出现进展、复发或死亡。低PFS患者在PRRT的第三个（P = 0.014）和第四个（P = 0.039）周期前显示ALP相对显著升高。Kaplan-Meier分析显示，治疗期间ALP值降低（Δ>10%）的患者中位PFS为24.3个月（95%CI，20.7 - 27.8个月），ALP值升高（Δ>10%）的患者为12.5个月（95%CI，9.2 - 15.8个月），ALP值稳定（Δ±10%）的患者为17.7个月（95%CI，13.6 - 21.8个月）。
基于这些探索性数据，血浆ALP升高可能表明疾病进展，在治疗期间应谨慎解读。
