Purpose: 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). Patients and 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) and18F-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 after223Ra (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 with223Ra, 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 to223Ra in the interim study, have proven to be solid and useful variables in the creation of nomograms for predicting therapeutic failure and OS.
目的：本研究旨在构建一个列线图模型，用于预测接受二氯化镭-223（223Ra）治疗的去势抵抗性前列腺癌骨转移（CRPC-BM）患者的治疗失败、骨骼事件及总生存期（OS）。患者与方法：自2015年1月至2022年12月，来自西班牙卡斯蒂利亚-拉曼查地区的患者前瞻性纳入ChoPET-Rad多中心研究。患者在基线期、中期及治疗结束时接受骨闪烁扫描（BS）和18F-氟胆碱PET/CT（FCH PET/CT）检查，获取多项影像组学特征，并在随访期间收集临床及生化变量，分析其与预设终点的关联性。生存分析采用Kaplan-Meier法和Cox回归模型。通过多变量逻辑回归和Cox回归构建模型，并以列线图形式呈现。结果：中位无进展生存期（PFS）和OS分别为4个月和14个月。与治疗失败独立且显著相关的变量包括基线碱性磷酸酶（AP）水平（p=0.022）和PET/CT中CT部分的骨转移特征（p=0.017）。对于OS，显著相关变量包括治疗失败（p=0.038）、223Ra治疗后接受的治疗线数（p<0.001）、平均SUVmax值（p=0.002）、FCH PET/CT中的骨髓浸润（p=0.006）以及中期FCH PET/CT疗效评估（p=0.048）。最终列线图整合了这些变量，在本研究纳入的100例患者中显示出良好的区分度。在骨骼事件分析中，仅OS在多变量分析中呈现显著关联，导致列线图设计缺乏一致性。结论：FCH PET/CT可作为评估患者是否适合接受223Ra治疗及随访监测的有效工具。其衍生指标——如CT中骨转移的形态特征、骨髓浸润情况及中期疗效评估结果——在构建预测治疗失败和OS的列线图模型中均被证实为稳健且实用的变量。
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