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Abstract：
BACKGROUND: Pretherapeutic chromogranin A, alkaline phosphatase (ALP), or De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) are prognostic factors in patients with metastatic neuroendocrine tumors (NET) undergoing peptide receptor radionuclide therapy (PRRT). However, their value for intratherapeutic monitoring remains unclear. We evaluated if changes in plasma markers during PRRT can help identify patients with unfavorable outcomes.
METHODS: A monocentric retrospective analysis of 141 patients with NET undergoing PRRT with [177Lu]Lu-DOTATOC was conducted. Changes in laboratory parameters were calculated by dividing the values determined immediately before each cycle of PRRT by the pretherapeutic value. Patients with low vs. high PFS were compared with the Wilcoxon rank-sum test.
RESULTS: Progression, relapse, or death after PRRT was observed in 103/141 patients. Patients with low PFS showed a significant relative ALP increase before the third (p = 0.014) and fourth (p = 0.039) cycles of PRRT. Kaplan-Meier analysis revealed a median PFS of 24.3 months (95% CI, 20.7-27.8 months) in patients with decreasing ALP values (Δ > 10%) during treatment, 12.5 months (95% CI, 9.2-15.8 months) in patients with increasing ALP values (Δ > 10%), and 17.7 months (95% CI, 13.6-21.8 months) with stable ALP values (Δ ± 10%).
CONCLUSIONS: Based on these exploratory data, a rise in plasma ALP might indicate disease progression and should be interpreted cautiously during therapy.
METHODS: A monocentric retrospective analysis of 141 patients with NET undergoing PRRT with [177Lu]Lu-DOTATOC was conducted. Changes in laboratory parameters were calculated by dividing the values determined immediately before each cycle of PRRT by the pretherapeutic value. Patients with low vs. high PFS were compared with the Wilcoxon rank-sum test.
RESULTS: Progression, relapse, or death after PRRT was observed in 103/141 patients. Patients with low PFS showed a significant relative ALP increase before the third (p = 0.014) and fourth (p = 0.039) cycles of PRRT. Kaplan-Meier analysis revealed a median PFS of 24.3 months (95% CI, 20.7-27.8 months) in patients with decreasing ALP values (Δ > 10%) during treatment, 12.5 months (95% CI, 9.2-15.8 months) in patients with increasing ALP values (Δ > 10%), and 17.7 months (95% CI, 13.6-21.8 months) with stable ALP values (Δ ± 10%).
CONCLUSIONS: Based on these exploratory data, a rise in plasma ALP might indicate disease progression and should be interpreted cautiously during therapy.
摘要：
背景：治疗前嗜铬粒蛋白A，碱性磷酸酶(ALP),或DeRitis比率（天冬氨酸转氨酶/丙氨酸转氨酶）是接受肽受体放射性核素治疗（PRRT）的转移性神经内分泌肿瘤（NET）患者的预后因素。然而,它们对治疗内监测的价值尚不清楚.我们评估了PRRT期间血浆标志物的变化是否可以帮助识别预后不良的患者。
方法：对141例接受[177Lu]Lu-DOTATOCPRRT的NET患者进行单中心回顾性分析。通过将每个PRRT周期之前立即确定的值除以治疗前值来计算实验室参数的变化。低vs.患者将高PFS与Wilcoxon秩和检验进行比较。
结果：进展，复发,在103/141例患者中观察到PRRT后死亡。PFS低的患者在PRRT的第三个（p=0.014）和第四个（p=0.039）周期之前显示出相对ALP的显着增加。Kaplan-Meier分析显示，治疗期间ALP值降低（Δ>10％）的患者的中位PFS为24.3个月（95％CI，20.7-27.8个月）。ALP值升高（Δ>10％）的患者12.5个月（95％CI，9.2-15.8个月），17.7个月（95％CI，13.6-21.8个月），ALP值稳定（Δ±10％）。
结论：基于这些探索性数据，血浆ALP升高可能提示疾病进展,治疗期间应谨慎解读.
方法：对141例接受[177Lu]Lu-DOTATOCPRRT的NET患者进行单中心回顾性分析。通过将每个PRRT周期之前立即确定的值除以治疗前值来计算实验室参数的变化。低vs.患者将高PFS与Wilcoxon秩和检验进行比较。
结果：进展，复发,在103/141例患者中观察到PRRT后死亡。PFS低的患者在PRRT的第三个（p=0.014）和第四个（p=0.039）周期之前显示出相对ALP的显着增加。Kaplan-Meier分析显示，治疗期间ALP值降低（Δ>10％）的患者的中位PFS为24.3个月（95％CI，20.7-27.8个月）。ALP值升高（Δ>10％）的患者12.5个月（95％CI，9.2-15.8个月），17.7个月（95％CI，13.6-21.8个月），ALP值稳定（Δ±10％）。
结论：基于这些探索性数据，血浆ALP升高可能提示疾病进展,治疗期间应谨慎解读.
