Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial
Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial
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DOI：
10.1007/s00259-014-2872-x
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发表时间：
2014-12-01
影响因子：
9.1
通讯作者：
Fanti, Stefano
中科院分区：
文献类型：
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作者：
Ceci, Francesco;Herrmann, Ken;Fanti, Stefano
这项回顾性双中心研究的目的是调查C-11-胆碱PET/CT对根治性治疗后复发性前列腺癌（rPCa）患者治疗管理决策的临床影响。（95例来自博洛尼亚，55例来自维尔茨堡）根治性治疗后rPCa和生化复发（PSA平均值+/- SD 4.3 +/- 5.5 ng/mL，范围0.2-39.4 ng/mL）。PET/CT前的预期治疗为95例患者的前列腺床挽救性放疗和55例患者的姑息性雄激素剥夺治疗（ADT）。C-11-胆碱PET/CT的有效临床影响被评定为重大（治疗方法的改变）、轻微（相同治疗，但修改了治疗策略）或无。多因素Logistic回归分析包括PSA水平、PSA动力学、持续ADT、Gleason评分、TNM、年龄和复发时间。150例患者中有70例（46.7%）在C-11-胆碱PET/CT后实施了治疗改变。在27例患者（18%）中观察到重大临床影响，在43例患者（28.7%）中观察到轻微临床影响。109名患者（72.7%）的C-11-胆碱PET/CT为阳性，64名患者（42.7%）检测到局部复发（前列腺床和/或髂淋巴结和/或直肠旁淋巴结）。31例患者（20.7%）出现远处复发（主动脉旁和/或腹膜后淋巴结和/或骨病变），14例（9.3%）出现局部和远处复发。PET阳性与阴性患者PSA水平及PSA动力学差异有统计学意义（p < 0.05）。在多因素分析中，PSA水平、PSA倍增时间和持续ADT是阳性扫描的显著预测因素（p < 0.05）。在统计学分析中，博洛尼亚和维尔茨堡患者之间没有观察到显著差异（p > 0.05）。在这两个中心中，使用相同的标准来验证PET阳性结果：在17.3%的患者中通过组织学，在82.7%的患者中通过相关成像和/或临床随访（随访平均20.5个月，中位数18.3个月，范围6.2-60个月）X-ll-胆碱PET/CT对rPCa患者的治疗管理具有显著影响。它导致46.7%的患者发生总体变化，18%的患者发生重大临床变化。需要进一步的前瞻性研究来评估这种治疗变化对患者生存率的影响。
The aim of this retrospective two-centre study was to investigate the clinical impact of C-11-choline PET/CT on treatment management decisions in patients with recurrent prostate cancer (rPCa) after radical therapy.Enrolled in this retrospective study were 150 patients (95 from Bologna, 55 from Wurzburg) with rPCa and biochemical relapse (PSA mean +/- SD 4.3 +/- 5.5 ng/mL, range 0.2-39.4 ng/mL) after radical therapy. The intended treatment before PET/CT was salvage radiotherapy of the prostatic bed in 95 patients and palliative androgen deprivation therapy (ADT) in 55 patients. The effective clinical impact of C-11-choline PET/CT was rated as major (change in therapeutic approach), minor (same treatment, but modified therapeutic strategy) or none. Multivariate binary logistic regression analysis included PSA level, PSA kinetics, ongoing ADT, Gleason score, TNM, age and time to relapse.Changes in therapy after C-11-choline PET/CT were implemented in 70 of the 150 patients (46.7 %). A major clinical impact was observed in 27 patients (18 %) and a minor clinical impact in 43 (28.7 %). C-11-choline PET/CT was positive in 109 patients (72.7 %) detecting local relapse (prostate bed and/or iliac lymph nodes and/or pararectal lymph nodes) in 64 patients (42.7 %). Distant relapse (paraaortic and/or retroperitoneal lymph nodes and/or bone lesions) was seen in 31 patients (20.7 %), and both local and distant relapse in 14 (9.3 %). A significant difference was observed in PSA level and PSA kinetics between PET-positive and PET-negative patients (p < 0.05). In multivariate analysis, PSA level, PSA doubling time and ongoing ADT were significant predictors of a positive scan (p < 0.05). In statistical analysis no significant differences were observed between the Bologna and Wurzburg patients (p > 0.05). In both centres the same criteria to validate PET-positive findings were used: in 17.3 % of patients by histology and in 82.7 % of patients by correlative imaging and/or clinical follow-up (follow-up mean 20.5 months, median 18.3 months, range 6.2-60 months).C-11-Choline PET/CT had a significant impact on therapeutic management in rPCa patients. It led to an overall change in 46.7 % of patients, with a major clinical change implemented in 18 % of patients. Further prospective studies are needed to evaluate the effect of such treatment changes on patient survival.