The oncologist · 2026
Novel risk scoring system for patients with metastatic castration-resistant prostate cancer treated with lutetium-177-PSMA-617.
СтатьяНазвание и аннотация: Перевод в очереди
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Gerke Margo B, Marra Angelo, Jayaraj Michelle, Yildrim Ahmet, Bedmutha Akshay, Brown Jacqueline T, Nazha Bassel, Berchuck Jacob E, Parikh Ravi Bharat, Ahmed Shahid, Ciuro Jordan Alana, Hartman Caitlin, McClintock Greta Russler, Caulfield Sarah, Kucuk Omer, Carthon Bradley Curtis, Schuster David M, Muzahir Saima, Liu Yuan, Bilen Mehmet Asim
Аннотация
PURPOSE: Lutetium-177(177Lu)-PSMA-617 improves survival for patients with metastatic castration-resistant prostate cancer, but outcomes are heterogeneous and standardized risk stratification tools are lacking. We developed a novel risk stratification tool for patients treated with 177Lu-PSMA-617.
METHODS: We conducted a retrospective analysis of 163 patients at Emory Winship Cancer Institute. Four prognostic models using Cox proportional hazards models were constructed using best-subset variable selection and integrated into a composite model.
RESULTS: Among the 163 patients (52% White, 44% Black; 80% previous taxane use) body mass index decline during treatment was associated with shorter progression-free survival (PFS) and overall survival (OS) (HR = 1.75, P = .03; HR = 2.35, P = .031). Higher subcutaneous adipose tissue index (SATI)/skeletal muscle index (SMI) was independently associated with improved OS (HR = 0.5, P = .019), whereas higher visceral adipose tissue index (VATI)/SATI was independently associated with worse OS (HR = 2.62, P = .005). A body composition-based prognostic score identified VATI/SATI, SMI, and total adiposity as the strongest OS predictors (C = 0.629). The composite score incorporating inflammatory biomarkers and body composition demonstrated good discrimination (C-index = 0.732) and effectively stratified patients by PFS and OS. For PFS, relative risks across increasing risk quartiles were 0.34, 0.40, and 0.62 in compared with the highest risk quartile (P = .034). For OS, corresponding hazard ratios were 0.15, 0.19, and 0.54 (P = .003).
CONCLUSIONS: A risk score incorporating body composition and inflammatory biomarkers demonstrates prognostic value for patients treated with 177Lu-PSMA-617.
METHODS: We conducted a retrospective analysis of 163 patients at Emory Winship Cancer Institute. Four prognostic models using Cox proportional hazards models were constructed using best-subset variable selection and integrated into a composite model.
RESULTS: Among the 163 patients (52% White, 44% Black; 80% previous taxane use) body mass index decline during treatment was associated with shorter progression-free survival (PFS) and overall survival (OS) (HR = 1.75, P = .03; HR = 2.35, P = .031). Higher subcutaneous adipose tissue index (SATI)/skeletal muscle index (SMI) was independently associated with improved OS (HR = 0.5, P = .019), whereas higher visceral adipose tissue index (VATI)/SATI was independently associated with worse OS (HR = 2.62, P = .005). A body composition-based prognostic score identified VATI/SATI, SMI, and total adiposity as the strongest OS predictors (C = 0.629). The composite score incorporating inflammatory biomarkers and body composition demonstrated good discrimination (C-index = 0.732) and effectively stratified patients by PFS and OS. For PFS, relative risks across increasing risk quartiles were 0.34, 0.40, and 0.62 in compared with the highest risk quartile (P = .034). For OS, corresponding hazard ratios were 0.15, 0.19, and 0.54 (P = .003).
CONCLUSIONS: A risk score incorporating body composition and inflammatory biomarkers demonstrates prognostic value for patients treated with 177Lu-PSMA-617.