Hartrampf Philipp E, Hüttmann Thomas, Seitz Anna Katharina, Kübler Hubert, Serfling Sebastian E, Higuchi Takahiro, Schlötelburg Wiebke, Michalski Kerstin, Gafita Andrei, Rowe Steven P, Pomper Martin G, Buck Andreas K, Werner Rudolf A
Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany;
Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
J Nucl Med. 2024 Apr 1;65(4):560-565. doi: 10.2967/jnumed.123.266702.
In metastatic castration-resistant prostate cancer (mCRPC) patients treated with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), the recently proposed criteria for evaluating response to PSMA PET (RECIP 1.0) based on Ga- and F-labeled PET agents provided prognostic information in addition to changes in prostate-specific antigen (PSA) levels. Our aim was to evaluate the prognostic performance of this framework for overall survival (OS) in patients undergoing RLT and imaged with [F]PSMA-1007 PET/CT and compare the prognostic performance with the PSA-based response assessment. In total, 73 patients with mCRPC who were scanned with [F]PSMA-1007 PET/CT before and after 2 cycles of RLT were retrospectively analyzed. We calculated the changes in serum PSA levels (ΔPSA) and quantitative PET parameters for the whole-body tumor burden (SUV, SUV, PSMA tumor volume, and total lesion PSMA). Men were also classified following the Prostate Cancer Working Group 3 (PCWG3) criteria for ΔPSA and RECIP 1.0 for PET imaging response. We performed univariable Cox regression analysis, followed by multivariable and Kaplan-Meier analyses. Median OS was 15 mo with a median follow-up time of 14 mo. Univariable Cox regression analysis provided significant associations with OS for ΔPSA (per percentage, hazard ratio [HR], 1.004; 95% CI, 1.002-1.007; < 0.001) and PSMA tumor volume (per unit, HR, 1.003; 95% CI, 1.000-1.005; = 0.03). Multivariable Cox regression analysis confirmed ΔPSA (per percentage, HR, 1.004; 95% CI, 1.001-1.006; = 0.006) as an independent prognosticator for OS. Kaplan-Meier analyses provided significant segregation between individuals with versus those without any PSA response (19 mo vs. 14 mo; HR, 2.00; 95% CI, 0.95-4.18; = 0.04). Differentiation between patients with or without progressive disease (PD) was also feasible when applying PSA-based PCWG3 (19 mo vs. 9 mo for non-PD and PD, respectively; HR, 2.29; 95% CI, 1.03-5.09; = 0.01) but slightly failed when applying RECIP 1.0 ( = 0.08). A combination of both response systems (PCWG3 and RECIP 1.0), however, yielded the best discrimination between individuals without versus those with PD (19 mo vs. 8 mo; HR, 2.78; 95% CI, 1.32-5.86; = 0.002). In patients with mCRPC treated with RLT and imaged with [F]PSMA-1007, frameworks integrating both the biochemical (PCWG3) and PET-based response (RECIP 1.0) may best assist in identifying subjects prone to disease progression.
在接受前列腺特异性膜抗原（PSMA）靶向放射性配体疗法（RLT）治疗的转移性去势抵抗性前列腺癌（mCRPC）患者中，最近基于镓和氟标记的PET显像剂提出的评估PSMA PET反应的标准（RECIP 1.0），除了能反映前列腺特异性抗原（PSA）水平变化外，还提供了预后信息。我们的目的是评估该框架对接受RLT治疗并进行[F]PSMA - 1007 PET/CT显像患者的总生存期（OS）的预后评估性能，并将其与基于PSA的反应评估的预后性能进行比较。总共对73例mCRPC患者进行了回顾性分析，这些患者在RLT的2个周期前后均接受了[F]PSMA - 1007 PET/CT扫描。我们计算了血清PSA水平的变化（ΔPSA）以及全身肿瘤负荷的PET定量参数（SUV、SUV、PSMA肿瘤体积和总病变PSMA）。还根据前列腺癌工作组3（PCWG3）的ΔPSA标准和PET显像反应的RECIP 1.0标准对患者进行了分类。我们进行了单变量Cox回归分析，随后进行多变量分析和Kaplan - Meier分析。中位总生存期为15个月，中位随访时间为14个月。单变量Cox回归分析显示，ΔPSA（每百分比，风险比[HR]，1.004；95%可信区间[CI]，1.002 - 1.007；P < 0.001）和PSMA肿瘤体积（每单位，HR，1.003；95% CI，1.000 - 1.005；P = 0.03）与总生存期显著相关。多变量Cox回归分析证实ΔPSA（每百分比，HR，1.004；95% CI，1.001 - 1.006；P = 0.006）是总生存期的独立预后因素。Kaplan - Meier分析显示，有PSA反应与无PSA反应的个体之间存在显著差异（19个月对14个月；HR，2.00；95% CI，0.95 - 4.18；P = 0.04）。应用基于PSA的PCWG3标准时，区分有无疾病进展（PD）的患者也是可行的（非PD和PD患者分别为19个月对9个月；HR，2.29；95% CI，1.03 - 5.09；P = 0.01），但应用RECIP 1.0标准时略有不足（P = 0.08）。然而，将两种反应系统（PCWG3和RECIP 1.0）结合使用，在区分无PD与有PD的个体方面效果最佳（19个月对8个月；HR，2.78；95% CI，1.32 - 5.86；P = 0.002）。在接受RLT治疗并进行[F]PSMA - 1007显像的mCRPC患者中，整合生化（PCWG3）和基于PET的反应（RECIP 1.0）的框架可能最有助于识别易于疾病进展的患者。
