背景:立体定向放射治疗(SBRT)是一种有效的转移导向治疗,用于治疗寡转移前列腺癌患者。然而,它缺乏可靠的危险分层生物标志物.循环肿瘤细胞(CTC)有望作为微创预后指标。这项研究评估了CTC在低复发激素敏感性前列腺癌(或HSPC)中的预后价值。
方法:或HSPC患者有1-3个淋巴结和/或骨转移,接受SBRT(N=35),中位随访时间为42.1个月。在基线(T0)测量CTC水平,1个月(T1),和3个月(T2)后SBRT使用新的基于代谢的测定。通过Cox回归和Kaplan-Meier分析,这些水平与临床结果相关。
结果:CTC计数中位数在T0为5,在T1为8,在T2为5,随着时间的推移没有显著变化。多变量分析确定了高(≥5/7.5mL)T0CTC计数(HR2.9,95%CI1.3-6.5,p=0.01,中位DPFS29.7vs.14.0个月),并且有一次以上的转移(HR3.9,95%CI1.8-8.6,p<0.005,中位DPFS34.1vs.10.7个月)作为远处无进展生存期(DPFS)的独立预测因子。CTC评估成功对单个转移患者进行了分层(HR3.4,95%CI1.1-10.2,p=0.03,中位DPFS42.1vs.16.7个月),但不是那些有一个以上转移的人。此外,基于CTC水平和转移数量的综合评分可有效地对患者进行分层.
结论:该研究表明,高代谢CTC可以增强接受SBRT的orHSPC患者的风险分层,特别是在转移负担有限的患者中,有可能识别出适合定制SBRT干预的惰性疾病患者。
BACKGROUND: Stereotactic body radiation therapy (SBRT) is an effective metastasis-directed therapy for managing oligometastatic prostate cancer patients. However, it lacks reliable biomarkers for risk stratification. Circulating Tumor Cells (CTC) show promise as minimally invasive prognostic indicators. This study evaluates the prognostic value of CTC in oligorecurrent hormone-sensitive prostate cancer (orHSPC).
METHODS: orHSPC patients with 1-3 nodal and/or bone metastases undergoing SBRT were enrolled (N = 35), with a median follow-up time of 42.1 months. CTC levels were measured at baseline (T0), 1 month (T1), and 3 months (T2) post-SBRT using a novel metabolism-based assay. These levels were correlated with clinical outcomes through Cox-regression and Kaplan-Meier analyses.
RESULTS: Median CTC counts were 5 at T0, 8 at T1, and 5 at T2 with no significant variation over time. Multivariate analysis identified high (≥5/7.5 mL) T0 CTC counts (HR 2.9, 95% CI 1.3-6.5, p = 0.01, median DPFS 29.7 vs. 14.0 months) and having more than one metastasis (HR 3.9, 95% CI 1.8-8.6, p < 0.005, median DPFS 34.1 vs. 10.7 months) as independent predictors of distant progression-free survival (DPFS). CTC assessment successfully stratified patients with a single metastasis (HR 3.4, 95% CI 1.1-10.2, p = 0.03, median DPFS 42.1 vs. 16.7 months), but not those with more than one metastasis. Additionally, a combined score based on CTC levels and the number of metastases effectively stratified patients.
CONCLUSIONS: The study demonstrates that hypermetabolic CTC could enhance risk stratification in orHSPC patients undergoing SBRT, particularly in patients with limited metastatic burden, potentially identifying patients with indolent disease who are suitable for tailored SBRT interventions.