Impact of anatomic location of bone metastases on prognosis in metastatic castration-resistant prostate cancer Journal Article

Authors: Roth, A. R.; Harmon, S. A.; Perk, T. G.; Eickhoff, J.; Choyke, P. L.; Kurdziel, K. A.; Dahut, W. L.; Apolo, A. B.; Morris, M. J.; Perlman, S. B.; Liu, G.; Jeraj, R.
Article Title: Impact of anatomic location of bone metastases on prognosis in metastatic castration-resistant prostate cancer
Abstract: Background: Whole-body assessments of 18F-NaF positron emission tomography (PET)/computed tomography (CT) provide promising quantitative imaging biomarkers of metastatic castration-resistant prostate cancer (mCRPC). This study investigated whether the distribution of metastases across anatomic regions is prognostic of progression-free survival. Patients and Methods: Fifty-four mCRPC patients with osseous metastases received baseline NaF PET/CT. Patients received chemotherapy (n = 16) or androgen receptor pathway inhibitors (n = 38). Semiautomated analysis using Quantitative Total Bone Imaging software extracted imaging metrics for the whole, axial, and appendicular skeleton as well as 11 skeletal regions. Five PET metrics were extracted for each region: number of lesions (NL), standardized maximum uptake value (SUVmax), average uptake (SUVmean), sum of uptake (SUVtotal), and diseased fraction of the skeleton (volume fraction). Progression included that discovered by clinical, biochemical, or radiographic means. Univariate and multivariate Cox proportional hazard regression analyses were performed between imaging metrics and progression-free survival, and were assessed according to their hazard ratios (HR) and concordance (C)-indices. Results: The strongest univariate models of progression-free survival were pelvic NL and SUVmax with HR = 1.80 (NL: false discovery rate adjusted P =.001, SUVmax: adjusted P =.001). Three other region-specific metrics (axial NL: HR = 1.59, adjusted P =.02, axial SUVmax: HR = 1.61, adjusted P =.02, and skull SUVmax: HR = 1.58, adjusted P =.04) were found to be stronger prognosticators relative to their whole-body counterparts. Multivariate model including region-specific metrics (C-index = 0.727) outperformed that of whole-body metrics (C-index = 0.705). The best performance was obtained when region-specific and whole-body metrics were included (C-index = 0.742). Conclusion: Quantitative characterization of metastatic spread by anatomic location on NaF PET/CT enhances potential prognostication. Further study is warranted to optimize the prognostic and predictive value of NaF PET/CT in mCRPC patients. © 2019 Elsevier Inc. Patients with metastatic castration-resistant prostate cancer can develop bone lesions throughout their skeleton. Previously the distribution of lesions and its impact on survival have been explored using 99mTc-methylene diphosphonate planar scintigraphy (bone scans), but not using the more sensitive 18F-NaF positron emission tomography/computed tomography. Several regional standard uptake values metrics were more prognostic of progression-free survival than their whole-body counterparts. © 2019 Elsevier Inc.
Keywords: adult; cancer chemotherapy; aged; shoulder; major clinical study; cancer localization; bone metastasis; cancer patient; positron emission tomography; pelvis; progression free survival; image analysis; retrospective study; docetaxel; cancer hormone therapy; health care; quantitative analysis; axial skeleton; pet; sternum; sacrum; leg; castration resistant prostate cancer; skeleton; distribution; clinical trial (topic); abiraterone; lumbar spine; thoracic spine; skull; cervical spine; arm; feature extraction; rib; orteronel; veliparib; cancer prognosis; enzalutamide; sodium fluoride f 18; disease burden; human; male; article; multicenter clinical trial; sodium fluoride; positron emission tomography-computed tomography; appendicular skeleton
Journal Title: Clinical Genitourinary Cancer
Volume: 17
Issue: 4
ISSN: 1558-7673
Publisher: Elsevier Inc.  
Date Published: 2019-08-01
Start Page: 306
End Page: 314
Language: English
DOI: 10.1016/j.clgc.2019.05.013
PUBMED: 31221545
PROVIDER: scopus
PMCID: PMC7331881
Notes: Article -- Source: Scopus
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MSK Authors
  1. Michael Morris
    501 Morris