目的:我们旨在开发一个能够预测治疗失败的列线图,骨骼事件,和总生存期(OS)的去势抵抗性前列腺癌伴骨转移(CRPC-BM)的患者用镭-223二氯(223Ra)治疗。
方法:2015年1月至2022年12月,来自Castilla-LaMancha西班牙地区的患者被前瞻性纳入ChoPET-Rad多中心研究。患者接受基线,临时,和治疗结束骨闪烁显像(BS)和18F-氟胆碱PET/CT(FCHPET/CT)扫描,在随访期间获取多个影像影像组学以及临床和生化变量,并研究它们与先前定义的终点的关联.使用Kaplan-Meier方法和Cox回归进行生存分析。计算多因素logistic和Cox回归模型,这些模型是通过列线图来描述的。
结果:中位无进展生存期(PFS)和OS分别为4个月和14个月(mo),分别。显示与治疗失败独立且显着相关的变量是基线碱性磷酸酶(AP)水平(p=0.022)和PET/CTCTCT部分的BM特征(p=0.017)。在OS的情况下,显著变量是治疗失败(p=0.038),223Ra后收到的线路数(p<0.001),平均SUVmax(p=0.002),FCHPET/CT中的骨髓浸润(p=0.006),和中期FCHPET/CT反应(p=0.048)。最终的列线图包括这些变量,在我们研究的100名患者中显示出良好的区分度。在骨骼事件的研究中,只有OS在多变量分析中显示出显著的关联,导致不一致的列线图设计。
结论:FCHPET/CT似乎是评估符合223Ra治疗条件的患者的良好工具,以及他们的后续行动。因此,从中得出的发现,如CT中BM的形态特征,骨髓浸润,或中期研究中对223Ra的反应,已被证明是创建用于预测治疗失败和OS的列线图的可靠和有用的变量。
OBJECTIVE: We aimed to develop a nomogram able to predict treatment failure, skeletal events, and overall survival (OS) in patients with castration-resistant prostate cancer with bone metastases (CRPC-BM) treated with Radium-223 dichloride (223Ra).
METHODS: Patients from the Castilla-La Mancha Spanish region were prospectively included in the ChoPET-Rad multicenter study from January 2015 to December 2022. Patients underwent baseline, interim, and end-of-treatment bone scintigraphy (BS) and 18F-Fluorocholine PET/CT (FCH PET/CT) scans, obtaining multiple imaging radiomics as well as clinical and biochemical variables during follow-up and studying their association with the previously defined end-points. Survival analysis was performed using the Kaplan-Meier method and Cox regression. Multivariate logistic and Cox regression models were calculated, and these models were depicted by means of nomograms.
RESULTS: Median progression-free survival (PFS) and OS were 4 and 14 months (mo), respectively. The variables that showed independent and significant association with therapeutic failure were baseline alkaline phosphatase (AP) levels (p = 0.022) and the characteristics of BM on the CT portion of PET/CT (p = 0.017). In the case of OS, the significant variables were therapeutic failure (p = 0.038), the number of lines received after 223Ra (p < 0.001), average SUVmax (p = 0.002), bone marrow infiltration in FCH PET/CT (p = 0.006), and interim FCH PET/CT response (p = 0.048). Final nomograms included these variables, showing good discrimination among the 100 patients included in our study. In the study of skeletal events, only OS showed a significant association in the multivariate analysis, resulting in an inconsistent nomogram design.
CONCLUSIONS: FCH PET/CT appears to be a good tool for evaluating patients eligible for treatment with 223Ra, as well as for their follow-up. Thus, findings derived from it, such as the morphological characteristics of BM in the CT, bone marrow infiltration, or the response to 223Ra in the interim study, have proven to be solid and useful variables in the creation of nomograms for predicting therapeutic failure and OS.