The aim of this retrospective study was to identify pre-therapeutic predictive laboratory and molecular imaging biomarkers for response and overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT). Pre-therapeutic laboratory and [68Ga]Ga-PSMA-11 PET/CT data ofn= 102 mCRPC patients receiving [177Lu]Lu-PSMA-617 RLT within a prospective registry (REALITY Study, NCT04833517) were analyzed including laboratory parameters such as alkaline phosphatase (ALP), prostate-specific antigen (PSA), gamma glutamyl transferase (GGT), glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), neuron specific enolase (NSE), hemoglobin (Hb), and imaging parameters such as maximum standardized uptake value of the tumor lesions (SUVmax), the mean standardized uptake value of all tumor lesions (SUVmean), the whole-body molecular tumor volume (MTV), and the whole-body total lesion PSMA (TLP). Mann–Whitney U test, univariate and multivariable Cox-regression were performed to test for association of the parameters with response and OS. The SUVmeanof all lesions was significantly different between responders and non-responders (SUVmeanresponders 8.95 ± 2.83 vs. non-responders 7.88 ± 4.46,p= 0.003), whereas all other tested biochemical and imaging parameters did not reveal significant differences. Hb and the molecular imaging parameters MTV and TLP showed a significant association with OS (p= 0.013,p= 0.005;p= 0.009) in univariant Cox regression; however, only TLP remained significant in multivariable analysis (Hazard ratio 1.033,p= 0.009). This study demonstrates a statistically significant association between the quantitative PET/CT imaging parameter SUVmeanand PSA response, as well as between the baseline TLP and OS of mCRPC patients undergoing RLT.
本回顾性研究旨在确定接受前列腺特异性膜抗原（PSMA）靶向放射性配体治疗（RLT）的转移性去势抵抗性前列腺癌（mCRPC）患者治疗前可预测疗效及总生存期（OS）的实验室与分子影像学生物标志物。研究分析了前瞻性登记研究（REALITY研究，NCT04833517）中102例接受[177Lu]Lu-PSMA-617 RLT治疗的mCRPC患者的治疗前实验室数据及[68Ga]Ga-PSMA-11 PET/CT影像数据，包括碱性磷酸酶（ALP）、前列腺特异性抗原（PSA）、γ-谷氨酰转移酶（GGT）、谷草转氨酶（GOT）、谷丙转氨酶（GPT）、神经元特异性烯醇化酶（NSE）、血红蛋白（Hb）等实验室参数，以及肿瘤病灶最大标准化摄取值（SUVmax）、所有病灶平均标准化摄取值（SUVmean）、全身分子肿瘤体积（MTV）和全身总病灶PSMA摄取量（TLP）等影像学参数。采用Mann-Whitney U检验、单变量及多变量Cox回归分析检验各参数与治疗反应及OS的相关性。结果显示，应答者与非应答者间所有病灶的SUVmean存在显著差异（应答者SUVmean 8.95 ± 2.83 vs. 非应答者7.88 ± 4.46，p=0.003），而其他所有生化及影像学参数均未显示显著差异。单变量Cox回归分析表明，Hb及分子影像学参数MTV、TLP与OS显著相关（p值分别为0.013、0.005、0.009）；但在多变量分析中，仅TLP保持显著相关性（风险比1.033，p=0.009）。本研究证实，定量PET/CT影像参数SUVmean与PSA应答率存在统计学显著关联，基线TLP与接受RLT治疗的mCRPC患者OS亦存在显著关联。
肿瘤(癌症)患者之家