Jafari Esmail, Manafi-Farid Reyhaneh, Ahmadzadehfar Hojjat, Salek Fatemeh, Jokar Narges, Keshavarz Ahmad, Divband GhasemAli, Dadgar Habibollah, Zohrabi Farshad, Assadi Majid
The Persian Gulf Nuclear Medicine Research Center, Department of Nuclear Medicine, Molecular Imaging, and Theranostics, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Nuklearmedizin. 2024 Dec;63(6):347-358. doi: 10.1055/a-2365-8113. Epub 2024 Sep 3.
In this study, we sought to identify the clinical baseline characteristics and pre-therapy 68Ga-PSMA PET derived parameters that can have impact on PSA (biochemical) response, OS and PSA PFS in patients with metastatic castration-resistant prostate cancer (mCRPC) who undergo RLT with [177Lu]Lu-PSMA-617.
Various pre-treatment clinical and PSMA PET derived parameters were gathered and computed. We used PSA response as the criteria for more than a 50% decrease in PSA level, and OS and PSA PFS as endpoints. We assessed the collected parameters in relation to PSA response. Additionally, we employed univariable Cox regression and Kaplan-Meier analysis with log rank to evaluate the influence of the parameters on OS and PFS.
A total of 125 mCRPC patients were included in this study. The median age was 68 years (range: 49-89). Among the cases, 77 patients (62%) showed PSARS, while 48 patients (38%) did not show PSA response. The median OS was 14 months (range: 1-60), and the median PSA-PFS was 10 months (range: 1-56). Age, prior history of chemotherapy, and SUVmax had a significant impact on PSA response (p<0.05). PSA response, RBC count, hemoglobin, hematocrit, neutrophil to lymphocyte ratio (NLR), alkaline phosphatase (ALP), number of metastases, wbPSMA-TV, and wbTL-PSMA significantly affected OS. GS, platelet count, NLR, and number of metastases were found to have a significant impact on PSA PFS.
We have identified several baseline clinical and PSMA PET derived parameters that can serve as prognostic factors for predicting PSA response, OS, and PSA PFS after RLT. Based on the findings, we believe that these clinical baseline characteristics can assist nuclear medicine specialists in identifying RLT responders who have long-term survival and PFS.
在本研究中，我们试图确定在接受[177Lu]Lu-PSMA-617放射性配体治疗（RLT）的转移性去势抵抗性前列腺癌（mCRPC）患者中，可能影响前列腺特异抗原（PSA，生化指标）反应、总生存期（OS）和PSA无进展生存期（PFS）的临床基线特征及治疗前68Ga-PSMA PET衍生参数。
收集并计算各种治疗前临床和PSMA PET衍生参数。我们将PSA反应定义为PSA水平下降超过50%的标准，并将OS和PSA PFS作为终点指标。我们评估所收集参数与PSA反应的关系。此外，我们采用单变量Cox回归和带有对数秩检验的Kaplan-Meier分析来评估这些参数对OS和PFS的影响。
本研究共纳入125例mCRPC患者。中位年龄为6۸岁（范围：49 - 89岁）。其中，77例患者（62%）显示出PSA反应性降低（PSARS），而48例患者（38%）未显示出PSA反应。中位OS为14个月（范围：1 - 60个月），中位PSA-PFS为10个月（范围：1 - 56个月）。年龄、既往化疗史和最大标准化摄取值（SUVmax）对PSA反应有显著影响（p<0.05）。PSA反应、红细胞计数、血红蛋白、血细胞比容、中性粒细胞与淋巴细胞比值（NLR）、碱性磷酸酶（ALP）、转移灶数量、全身PSMA总摄取体积（wbPSMA-TV）和全身PSMA转运时间（wbTL-PSMA）对OS有显著影响。 Gleason评分（GS）、血小板计数、NLR和转移灶数量对PSA PFS有显著影响。
我们已经确定了几个基线临床和PSMA PET衍生参数，这些参数可作为预测RLT后PSA反应、OS和PSA PFS的预后因素。基于这些发现，我们认为这些临床基线特征可以帮助核医学专家识别具有长期生存和PFS的RLT反应者。
