双时间点治疗后177Lu-PSMA-617 SPECT/CT描述了mCRPC病变的摄取动力学和预测患者的预后。

IF 9.1 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Manuela Straub, Jürgen Kupferschläger, Lina Maria Serna Higuita, Matthias Weissinger, Helmut Dittmann, Christian la Fougère, Francesco Fiz
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引用次数: 0

摘要

177Lu-PSMA-617是转移性去势抵抗性前列腺癌(mCRPC)的有效治疗选择。然而,一些患者在治疗过程中出现了进展。我们假设转移灶内的示踪剂动力学可能会影响治疗效果,并通过分析连续两次治疗后SPECT/CT扫描的摄取参数来验证这一假设。方法:回顾性纳入经177Lu-PSMA-617治疗的mCRPC患者,并在治疗后(第一次治疗后24和48小时)进行SPECT/CT成像。在SPECT/CT扫描中,对淋巴结转移(LNM)和骨转移(BM)确定感兴趣的体积。计算两次SPECT/CT扫描之间注射剂量百分比(%IDred)的减少。我们比较了有反应者(在2个周期的177Lu-PSMA-617治疗后前列腺特异性抗原下降≥50%)和无反应者的%IDred。我们使用单变量Kaplan-Meier (KM)分析和多变量Cox回归模型检验了%IDred与无进展生存期和总生存期(OS)的关系。结果:55例患者(中位年龄73岁;范围:54-87岁)。无应答者LNM和BM的IDred %大于应答者(LNM,无应答者36%[四分位间距(IQR), 26%-47%],应答者24% [IQR, 12%-33%] [P = 0.003];对于BM,无应答者为35% [IQR, 27%-52%],应答者为18% [IQR, 15%-29%] [P = 0.002])。对于无进展生存期,在KM分析中,较大的LNM (P = 0.008)和BM (P = 0.001)的IDred %与较短的生存期相关,而在多变量分析中,仅保留了LNM的%IDred (P = 0.03)。在OS的单变量KM分析中,BM的IDred百分比越大,生存期越短(P = 0.002)。在多变量OS分析中,BM %IDred保持不变(P = 0.009)。结论:mCRPC转移灶的177Lu-PSMA-617清除率似乎是反应和生存的相关预测指标,清除速度越快可能意味着放射性药物停留时间和吸收剂量越短。双时间点分析似乎是一种可行和容易获得的方法来估计反应的可能性和患者的生存。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dual-Time-Point Posttherapy 177Lu-PSMA-617 SPECT/CT Describes the Uptake Kinetics of mCRPC Lesions and Prognosticates Patients' Outcome.

177Lu-PSMA-617 is an effective therapeutic option in metastasized castration-resistant prostate cancer (mCRPC). However, some patients progress under treatment. We hypothesized that the tracer kinetics within the metastases may influence the therapy effectiveness and tested this hypothesis by analyzing uptake parameters on 2 consecutive posttherapy SPECT/CT scans. Methods: mCRPC patients treated with 177Lu-PSMA-617 and with available posttherapy SPECT/CT imaging (24 and 48 h after the first treatment) were enrolled retrospectively. Volumes of interest were defined on lymph node metastasis (LNM) and bone metastasis (BM) on both SPECT/CT scans. The reduction of the percentage injected dose (%IDred) between the 2 SPECT/CT scans was computed. We compared %IDred of responders (prostate-specific antigen drop ≥ 50% after 2 cycles of 177Lu-PSMA-617) and nonresponders. We tested the association of %IDred with progression-free survival and overall survival (OS) using a univariate Kaplan-Meier (KM) analysis and a multivariate Cox regression model. Results: Fifty-five patients (median age, 73 y; range, 54-87 y) were included. %IDred in LNM and BM was greater in nonresponders than in responders (for LNM, 36% in nonresponders [interquartile range (IQR), 26%-47%] vs. 24% in responders [IQR, 12%-33%] [P = 0.003]; for BM, 35% in nonresponders [IQR, 27%-52%] vs. 18% in responders [IQR, 15%-29%] [P = 0.002]). For progression-free survival, in KM analysis, greater %IDred in LNM (P = 0.008) and BM (P = 0.001) was associated with shorter survival, whereas in multivariate analysis, only %IDred in LNM was retained (P = 0.03). In univariate KM analysis of OS, greater %IDred in BM was associated with shorter survival (P = 0.002). In multivariate OS analysis, BM %IDred (P = 0.009) was retained. Conclusion: The 177Lu-PSMA-617 clearance rate from mCRPC metastases appears to be a relevant prognosticator of response and survival, with faster clearing possibly signaling a shorter radiopharmaceutical residence time and absorbed dose. Dual-time-point analysis appears to be a feasible and readily available approach to estimate the likelihood of response and patients' survival.

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来源期刊
Journal of Nuclear Medicine
Journal of Nuclear Medicine 医学-核医学
CiteScore
13.00
自引率
8.60%
发文量
340
审稿时长
1 months
期刊介绍: The Journal of Nuclear Medicine (JNM), self-published by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), provides readers worldwide with clinical and basic science investigations, continuing education articles, reviews, employment opportunities, and updates on practice and research. In the 2022 Journal Citation Reports (released in June 2023), JNM ranked sixth in impact among 203 medical journals worldwide in the radiology, nuclear medicine, and medical imaging category.
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