使用PSMA PET/CT可提高接受挽救性放疗的生化复发前列腺癌男性患者的总生存率：来自一个国家的真实世界数据。
The Use of PSMA PET/CT Improves Overall Survival in Men with Biochemically Recurrent Prostate Cancer Treated with Salvage Radiotherapy: Real-World Data from an Entire Country.
作者信息
Mogensen Anna W, Torp-Pedersen Christian, Nørgaard Mette, Petersen Lars J, Moe Mette, Zacho Helle D
机构信息
Department of Nuclear Medicine, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark;
Nordsjællands Hospital, Hillerod, Denmark.
出版信息
J Nucl Med. 2025 Aug 1;66(8):1217-1222. doi: 10.2967/jnumed.125.269996.
International guidelines recommend salvage radiotherapy (sRT) as a curative treatment for men with biochemically recurrent prostate cancer after radical prostatectomy. Prostate-specific membrane antigen (PSMA) PET/CT has demonstrated high sensitivity for localizing recurrent disease at low prostate-specific antigen levels, enabling improved treatment decision-making. However, few studies have investigated the impact of pre-sRT PSMA PET/CT on patient-relevant outcomes, that is, recurrence-free and overall survival. Moreover, no comparison exists of overall survival between patients who underwent PSMA PET/CT and those who did not, before sRT. This study used real-world data (obtained from routine clinical practice) of all patients treated with sRT in Denmark from 2015 through 2023. Patients were categorized according to whether they underwent pretreatment PSMA PET/CT. Our main objective was to compare overall survival up to 5 y after completion of sRT. Biochemical recurrence-free survival (BRFS) was included as a secondary outcome. Only patients with a prostate-specific antigen value of 0.2-1.0 ng/mL were included. In total, 844 patients were treated with sRT during the study period, of whom 308 (36.5%) underwent pretreatment PSMA PET/CT. The analysis revealed greater overall survival for patients who underwent PSMA PET/CT before sRT than for patients who did not. The 1-, 2-, and 5-y survival rates for PSMA PET/CT patients were 100% (95% CI, 100%-100%), 99.5% (95% CI, 98.6%-100%), and 98.1% (95% CI, 96%-100%), respectively, versus 99% (95% CI, 98.2%-99.9%), 97.8% (95% CI, 96.5%-99.1%), and 93.8% (95% CI, 91.5%-96.2%), respectively, for non-PSMA PET/CT patients (crude hazard ratio, 3.31 [95% CI, 1.01-10.88]; = 0.0486). Comparatively, the 3-y BRFS rate was consistent with overall survival: 74.9% (95% CI, 68.5%-81.3%) for PSMA PET/CT patients and 69.4% (95% CI, 65.2%-73.7%) for non-PSMA PET/CT patients, with a hazard ratio of 1.53 (95% CI, 1.07-2.19; = 0.0187). PSMA PET/CT use before sRT was associated with improved overall survival and BRFS.
国际指南推荐挽救性放疗（sRT）作为根治性前列腺切除术后生化复发前列腺癌男性患者的一种治愈性治疗方法。前列腺特异性膜抗原（PSMA）PET/CT已显示出在低前列腺特异性抗原水平下定位复发疾病的高敏感性，有助于改善治疗决策。然而，很少有研究调查挽救性放疗前PSMA PET/CT对患者相关结局的影响，即无复发生存期和总生存期。此外，在挽救性放疗前，接受PSMA PET/CT检查的患者与未接受该检查的患者之间的总生存期尚无比较。本研究使用了丹麦2015年至2023年期间接受挽救性放疗的所有患者的真实世界数据（来自常规临床实践）。根据患者是否接受了治疗前PSMA PET/CT进行分类。我们的主要目标是比较挽救性放疗完成后5年内的总生存期。生化无复发生存期（BRFS）作为次要结局纳入研究。仅纳入前列腺特异性抗原值为0.2 - 1.0 ng/mL的患者。在研究期间，共有844例患者接受了挽救性放疗，其中308例（36.5%）接受了治疗前PSMA PET/CT检查。分析显示，在挽救性放疗前接受PSMA PET/CT检查的患者的总生存期长于未接受该检查的患者。接受PSMA PET/CT检查患者的1年、2年和5年生存率分别为100%（95%CI，100% - 100%）、99.5%（95%CI，98.6% - 100%）和98.1%（95%CI，96% - 100%），而未接受PSMA PET/CT检查患者的相应生存率分别为99%（95%CI，98.2% - 99.9%）、97.8%（95%CI，96.5% - 99.1%）和93.8%（95%CI，91.5% - 96.2%）（粗风险比，3.31 [95%CI，1.01 - 10.88]；P = 0.0486）。相比之下，3年BRFS率与总生存期一致：接受PSMA PET/CT检查患者为74.9%（95%CI，68.5% - 81.3%），未接受PSMA PET/CT检查患者为69.4%（95%CI，65.2% - 73.7%），风险比为1.53（95%CI，1.07 - 2.19；P = 0.0187）。挽救性放疗前使用PSMA PET/CT与改善总生存期和BRFS相关。
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