PSMA PET Validates Higher Rates of Metastatic Disease for European Association of Urology Biochemical Recurrence Risk Groups: An International Multicenter Study.
PSMA PET Validates Higher Rates of Metastatic Disease for European Association of Urology Biochemical Recurrence Risk Groups: An International Multicenter Study.
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DOI：
10.2967/jnumed.121.262821
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Piert M
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作者：
Ferdinandus J;Fendler WP;Farolfi A;Washington S;Mohamad O;Pampaloni MH;Scott PJH;Rodnick M;Viglianti BL;Eiber M;Herrmann K;Czernin J;Armstrong WR;Calais J;Hope TA;Piert M
欧洲泌尿外科协会（EAU）前列腺癌指南小组建议前列腺癌生化复发（BCR）的风险组，以确定进展或转移性疾病的高风险男性。PSMA引导的PET成像的快速增长将影响前列腺癌分期。我们确定了前列腺癌BCR和生化持久性（BCP）的局部和转移性疾病的发生率，并按EAU BCR风险组和BCP分层。研究方法：根据在3个研究中心进行的相同前瞻性临床试验方案，入组BCR或BCP患者（n = 1，777 [91%]：UCLA，n = 662 [NCT 02940262];加州大学旧金山分校弗朗西斯科，n = 508 [NCT 03353740];密歇根大学，n = 607 [NCT 03396874]）;回顾性纳入来自埃森大学、博洛尼亚大学和慕尼黑大学的183例BCP患者。BCR患者必须有足够的数据来确定EAU风险评分。应用多变量、二项逻辑回归模型来评估M1疾病的独立预测因素。结果：共纳入1，960例患者。根治性乳腺癌切除术后EAU BCR低风险、EAU BCR高风险和BCP组分别在43/176（24%）、342/931（37%）和154/386（40%）例患者中检出远处转移（M1）。对于放疗后EAU BCR低风险和EAU BCR高风险组，M1检出率分别为113/309（37%）和110/158（70%）。多因素回归分析显示，BCP、高危BCR和血清前列腺特异性抗原水平升高与PSMA PET M1疾病显著相关。PSMA PET显示25%的根治性乳腺癌切除术后或放射治疗后EAU BCR高风险患者无疾病，33%的患者仅局部区域疾病。结论：我们的研究结果支持新的EAU分类; EAU BCR高风险组在PSMA PET上的转移性疾病发生率高于低风险组。不一致的亚组，包括低风险患者中的转移性疾病和高风险患者中的无疾病，需要纳入PSMA PET分期以完善风险评估。
The European Association of Urology (EAU) prostate cancer guidelines panel recommends risk groups for biochemical recurrence (BCR) of prostate cancer to identify men at high risk of progression or metastatic disease. The rapidly growing availability of PSMA-directed PET imaging will impact prostate cancer staging. We determined the rates of local and metastatic disease in BCR and biochemical persistence (BCP) of prostate cancer stratified by EAU BCR risk groups and BCP. Methods: Patients with BCR or BCP were enrolled under the same prospective clinical trial protocol conducted at 3 sites (n = 1,777 [91%]: UCLA, n = 662 [NCT02940262]; University of California San Francisco, n = 508 [NCT03353740]; University of Michigan, n = 607 [NCT03396874]); 183 patients with BCP from the Universities of Essen, Bologna, and Munich were included retrospectively. Patients with BCR had to have sufficient data to determine the EAU risk score. Multivariate, binomial logistic regression models were applied to assess independent predictors of M1 disease. Results: In total, 1,960 patients were included. Post–radical prostatectomy EAU BCR low-risk, EAU BCR high-risk, and BCP groups yielded distant metastatic (M1) detection in 43 of 176 (24%), 342 of 931 (37%), and 154 of 386 (40%) patients. For postradiotherapy EAU BCR low-risk and EAU BCR high-risk groups, the M1 detection rate was 113 of 309 (37%) and 110 of 158 (70%), respectively. BCP, high-risk BCR, and higher levels of serum prostate-specific antigen were significantly associated with PSMA PET M1 disease in multivariate regression analysis. PSMA PET revealed no disease in 25% and locoregional-only disease in 33% of patients with post–radical prostatectomy or postradiotherapy EAU BCR high risk. Conclusion: Our findings support the new EAU classification; EAU BCR high-risk groups have higher rates of metastatic disease on PSMA PET than do the low-risk groups. Discordant subgroups, including metastatic disease in low-risk patients and no disease in high-risk patients, warrant inclusion of PSMA PET stage to refine risk assessment.