Prognostic significance of a negative PSMA PET/CT in biochemical recurrence of prostate cancer.

IF 3.5 2区 医学 Q2 ONCOLOGY
Sara Harsini, Patrick Martineau, Sonia Plaha, Heather Saprunoff, Catherine Chen, Julia Bishop, Scott Tyldesley, Don Wilson, François Bénard
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引用次数: 0

Abstract

Background: Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is becoming standard of care for men with biochemical recurrence (BCR) of prostate cancer. The implications of a negative PSMA PET/CT scan in this population remain unclear. This study aims to assess the outcome of patients with BCR post radical prostatectomy (RP) who have negative [18F]DCFPyL PET/CT scan at relapse.

Methods: This is a post-hoc subgroup analysis of a prospective non randomized clinical trial. One hundred and one patients (median age, 75 years) with BCR after RP, who tested negative on [18F]DCFPyL PET/CT and subsequently either underwent salvage radiotherapy (sRT) with or without androgen deprivation therapy (ADT) or were followed without active treatment, were included. Freedom from progression (FFP) after negative PSMA PET/CT was determined based on follow-up imaging selected as per clinical practice. Uni- and multivariate Cox regression analyses were performed to examine the association of patients' characteristics, tumor-specific variables, and treatment with clinical progression at the last follow-up. FFP at 1-, 2-, and 3-year were reported using Kaplan Meier analysis.

Results: The median PSA level at PET/CT was 0.56 ng/mL (range, 0.4-11.3). Sixty five (64%) patients were followed without receiving further treatment, and 36 (36%) received sRT (18% to the prostate bed only and 18% to the prostate bed and pelvic lymph nodes) within 3 months of the PSMA PET. Seventeen of the sRT patients (17 of 36, 47%) received concomitant androgen deprivation therapy (ADT). Median follow-up was 39 months. Subsequent clinical progression was detected in 21 patients (21%), with 52% in pelvic lymph nodes, 52% in the prostatic fossa, 19% in distant lymph nodes, 14% in lungs, and 10% in bones. The FFP was 95% (95% CI: 91%-99%) at 12 months, 87% (95% CI: 81%-94%) at 24 months, and 79% (95% CI: 71%-88%) at 36 months. Multivariate Cox regression analysis revealed that an initial International Society of Urological Pathology (ISUP) grade 5 was significantly associated with clinical progression at the last follow-up (hazard ratio, 5.1, P value, 0.04). Furthermore, the receipt of sRT correlated significantly with lower clinical progression at the last follow-up (hazard ratio, 0.2, P value, 0.03), whereas other clinical and tumor-specific parameters did not. Following surveillance-only and sRT, 29% (19 of 65) and 6% (2 of 36) of patients, respectively, showed clinical progression. In the sRT group, no significant difference was observed in FFP between patients who underwent sRT to the prostatic fossa versus those who received sRT to the prostatic fossa and pelvic lymph nodes, although the numbers in these groups were small.

Conclusions: This study suggests that salvage radiotherapy is associated with a decreased or delayed clinical progression in patients with biochemical recurrence following radical prostatectomy who have negative PSMA PET/CT scan results. The analysis also underscores the prognostic significance of the initial ISUP grade, with ISUP grade 5 being associated with worse outcomes.

Trial registration: Registered September 14, 2016; NCT02899312 .

PSMA PET/CT 阴性对前列腺癌生化复发的预后意义。
背景:前列腺特异性膜抗原(PSMA)正电子发射断层扫描/计算机断层扫描(PET/CT)已成为前列腺癌生化复发(BCR)男性的标准治疗方法。PSMA PET/CT 扫描阴性对这类人群的影响尚不清楚。本研究旨在评估前列腺癌根治术(RP)后复发时[18F]DCFPyL PET/CT扫描阴性的前列腺癌患者的预后:这是一项前瞻性非随机临床试验的事后亚组分析。研究纳入了 111 例 RP 术后 BCR 患者(中位年龄 75 岁),这些患者的[18F]DCFPyL PET/CT 检测结果为阴性,随后接受了带或不带雄激素剥夺疗法(ADT)的挽救性放疗(sRT),或在未接受积极治疗的情况下接受了随访。PSMA PET/CT 阴性后的进展自由度(FFP)是根据临床实践选择的随访成像结果确定的。对患者特征、肿瘤特异性变量和治疗方法与最后一次随访时临床进展的关系进行了单变量和多变量 Cox 回归分析。采用卡普兰-梅耶尔分析法报告了1年、2年和3年的FFP情况:PET/CT检查的PSA水平中位数为0.56纳克/毫升(范围为0.4-11.3)。65名(64%)患者在PSMA PET检查后未接受进一步治疗,36名(36%)患者在PSMA PET检查后3个月内接受了sRT治疗(18%仅对前列腺床进行治疗,18%对前列腺床和盆腔淋巴结进行治疗)。其中 17 名 sRT 患者(36 人中有 17 人,占 47%)同时接受了雄激素剥夺疗法 (ADT)。中位随访时间为 39 个月。21名患者(21%)发现了后续临床进展,其中52%发生在盆腔淋巴结,52%发生在前列腺窝,19%发生在远处淋巴结,14%发生在肺部,10%发生在骨骼。12个月时的FFP为95%(95% CI:91%-99%),24个月时为87%(95% CI:81%-94%),36个月时为79%(95% CI:71%-88%)。多变量考克斯回归分析显示,最初的国际泌尿病理学会(ISUP)5级与最后一次随访时的临床进展显著相关(危险比为5.1,P值为0.04)。此外,接受 sRT 与最后一次随访时较低的临床进展显著相关(危险比为 0.2,P 值为 0.03),而其他临床和肿瘤特异性参数则不相关。接受单纯监测和 sRT 治疗后,分别有 29% (65 例中的 19 例)和 6% (36 例中的 2 例)的患者出现临床进展。在sRT组中,前列腺窝接受sRT的患者与前列腺窝和盆腔淋巴结接受sRT的患者的FFP没有明显差异,尽管这两组的人数很少:本研究表明,对于 PSMA PET/CT 扫描结果为阴性的根治性前列腺切除术后生化复发患者,挽救性放疗与临床进展的减少或延迟有关。分析还强调了初始ISUP分级的预后意义,ISUP 5级与较差的预后相关:注册日期:2016年9月14日;NCT02899312 。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cancer Imaging
Cancer Imaging ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
7.00
自引率
0.00%
发文量
66
审稿时长
>12 weeks
期刊介绍: Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology. The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include: Breast Imaging Chest Complications of treatment Ear, Nose & Throat Gastrointestinal Hepatobiliary & Pancreatic Imaging biomarkers Interventional Lymphoma Measurement of tumour response Molecular functional imaging Musculoskeletal Neuro oncology Nuclear Medicine Paediatric.
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