Australian Centre for Quantitative Imaging, School of Medicine, The University of Western Australia, Perth, Australia.
AIQ Solutions, Madison, WI.
Clin Genitourin Cancer. 2024 Oct;22(5):102155. doi: 10.1016/j.clgc.2024.102155. Epub 2024 Jul 6.
Treatment of men with metastatic prostate cancer can be difficult due to the heterogeneity of response of lesions. [Ga]Ga-PSMA-11 (PSMA) PET/CT assists with monitoring and directing clinical intervention; however, the impact of response heterogeneity has yet to be related to outcome measures. The aim of this study was to assess the impact of quantitative imaging information on the value of PSMA PET/CT to assess patient outcomes in response evaluation.
Baseline and follow-up (6 months) PSMA PET/CT of 162 men with oligometastatic PC treated with standard clinical care were acquired between 2015 and 2016 for analysis. An augmentative software medical device was used to track lesions between scans and quantify lesion change to categorize them as either new, increasing, stable, decreasing, or disappeared. Quantitative imaging features describing the size, intensity, extent, change, and heterogeneity of change (based on percent change in SUV) among lesions were extracted and evaluated for association with overall survival (OS) using Cox regression models. Model performance was evaluated using the c-index.
Forty-one (25%) of subjects demonstrated heterogeneous response at follow-up, defined as having at least 1 new or increasing lesion and at least 1 decreasing or disappeared lesion. Subjects with heterogeneous response demonstrated significantly shorter OS than subjects without (median OS = 76.6 months vs. median OS not reached, P < .05, c-index = 0.61). In univariate analyses, SUV at follow-up was most strongly associated with OS (HR = 1.29 [1.19, 1.40], P < .001, c-index = 0.73). Multivariable models applied using heterogeneity of change features demonstrated higher performance (c-index = 0.79) than models without (c-index = 0.71-0.76, P < .05).
Augmentative software tools enhance the evaluation change on serial PSMA PET scans and can facilitate lesional evaluation between timepoints. This study demonstrates that a heterogeneous response at a lesional level may impact adversely on patient outcomes and supports further investigation to evaluate the role of imaging to guide individualized patient management to improve clinical outcomes.
由于病变反应的异质性，转移性前列腺癌男性的治疗可能较为困难。[Ga]Ga-PSMA-11（PSMA）PET/CT 有助于监测和指导临床干预；然而，反应异质性的影响尚未与结局测量相关。本研究旨在评估定量成像信息对 PSMA PET/CT 评估患者反应评估中患者结局的价值的影响。
2015 年至 2016 年期间，对 162 名接受标准临床治疗的寡转移性 PC 男性患者进行了基线和随访（6 个月）PSMA PET/CT 检查，用于分析。使用增强软件医疗设备在扫描之间跟踪病变并量化病变变化，将其归类为新出现、增加、稳定、减少或消失。提取描述病变之间大小、强度、程度、变化和变化异质性（基于 SUV 的百分比变化）的定量成像特征，并使用 Cox 回归模型评估与总生存（OS）的相关性。使用 C 指数评估模型性能。
41 名（25%）患者在随访时表现出异质性反应，定义为至少有 1 个新出现或增加的病变和至少 1 个减少或消失的病变。具有异质性反应的患者的 OS 明显短于没有异质性反应的患者（中位 OS = 76.6 个月与中位 OS 未达到，P <.05，C 指数 = 0.61）。在单变量分析中，随访时的 SUV 与 OS 最密切相关（HR = 1.29 [1.19, 1.40]，P <.001，C 指数 = 0.73）。使用异质性变化特征应用多变量模型显示出更高的性能（C 指数 = 0.79），优于不使用异质性变化特征的模型（C 指数 = 0.71-0.76，P <.05）。
增强软件工具增强了在连续 PSMA PET 扫描上评估变化的能力，并可促进在时间点之间进行病变评估。本研究表明，病变水平的异质性反应可能对患者结局产生不利影响，并支持进一步研究评估成像在指导个体化患者管理以改善临床结局中的作用。
