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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Primary tumor heterogeneity on pre-treatment [68Ga]Ga-PSMA PET/CT for the predic...
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Original Article
Primary tumor heterogeneity on pre-treatment [68Ga]Ga-PSMA PET/CT for the prediction of biochemical recurrence in prostate cancer
Heterogeneidad del tumor primario en la PET/TC con PSMA [68Ga]Ga previa al tratamiento para la predicción de la recurrencia bioquímica en el cáncer de próstata
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Seda Gülbahar Ateşa,
Corresponding author
sdsdglbhr@gmail.com

Corresponding author.
, Bedriye Büşra Demirelb, Esra Kekillic, Erdem Öztürkd, Gülin Uçmakb
a Department of Nuclear Medicine, Hitit University Erol Olçok Training and Research Hospital, Çorum, Turkey
b Department of Nuclear Medicine, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
c Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
d Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Received 12 March 2024. Accepted 12 June 2024
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Tables (4)
Table 1. The texture parameters extracted from 68Ga PSMA PET images.
Table 2. Clinicopathologic features of the patients.
Table 3. Univariate analysis results of clinicopathologic features and conventional PET parameters.
Table 4. The parameters significantly associated with BCR in the univariate and multivariate analyses.
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Abstract
Purpose

The aim of this study is to research the value of the texture analysis of primary tumors in pre-treatment [68Ga]Ga-PSMA PET in the prediction of the development of biochemical recurrence (BCR) in prostate cancer patients who underwent definitive therapies.

Methods

51 patients with prostate adenocarcinoma who had a pre-treatment [68Ga]Ga-PSMA-11 PET/CT and underwent definitive radiotherapy (RT) or radical prostatectomy (RP) were included in the study. Demographics, clinicopathologic features, the presence of BCR, and the last follow-up date of patients were recorded. Textural and conventional PET parameters (maximum standardized uptake value (SUVmax), total lesion-PSMA (TL-PSMA), and PSMA-tumor volume (PSMA-TV)) were obtained from PET/CT images using LifeX program. Parameters were grouped using the Youden index in ROC analysis. Factors predicting the BCR were determined using Cox regression analyses.

Results

29 (56.9%) patients have received primary curative RT, while the remaining 22 (43.1%) patients have undergone RP. 5 (22.7%) patients with RP and 3 (10.3%) patients with curative RT have developed BCR during the follow-up. INTENSITY-BASED-minimum grey level (P=.050), GLCM-sum variance (P=.019), and GLCM-cluster prominence (P=.050) were associated with BCR in univariate analysis. INTENSITY-BASED-minimum grey level (P=.009) and GLCM-sum variance (P=.004) were found as independent predictors of BCR in the multivariate analysis.

Conclusion

Tumor heterogeneity on pre-treatment [68Ga]Ga-PSMA PET is associated with a high risk of BCR in PCa patients who underwent definitive therapies.

Keywords:
[68Ga]Ga-PSMA PET
Prostate cancer
Radiomics
Texture analysis
Tumor heterogeneity
Resumen
Objetivo

El objetivo de este estudio es investigar el valor del análisis de textura de tumores primarios en PET con PSMA [68Ga]Ga pretratamiento en la predicción del desarrollo de recurrencia bioquímica (BCR) en pacientes con cáncer de próstata que se sometieron a terapias definitivas.

Métodos

Se incluyeron en el estudio 51 pacientes con adenocarcinoma de próstata a los que se les realizó una PET/TC con [68Ga]Ga-PSMA-11 pretratamiento y se sometieron a radioterapia (RT) definitiva o prostatectomía radical (PR). Se registraron las características demográficas, clínico-patológicas, la presencia de BCR y la última fecha de seguimiento de los pacientes. Los parámetros de PET texturales y convencionales (valor máximo de captación estandarizado (SUVmax), lesión total-PSMA (TL-PSMA) y volumen tumoral de PSMA (PSMA-TV)) se obtuvieron a partir de imágenes PET/CT utilizando el programa LifeX. Los parámetros se agruparon utilizando el índice de Youden en el análisis ROC. Los factores que predicen el BCR se determinaron mediante análisis de regresión de Cox.

Resultados

29 (56,9%) pacientes recibieron RT curativa primaria, mientras que los 22 (43,1%) pacientes restantes se sometieron a PR. 5 (22,7%) pacientes con PR y 3 (10,3%) pacientes con RT curativa desarrollaron BCR durante el seguimiento. El nivel de gris mínimo BASADO EN LA INTENSIDAD (P=,050), la varianza de la suma GLCM (P=,019) y la prominencia del grupo GLCM (P=,050) se asociaron con BCR en el análisis univariado. El nivel de gris mínimo BASADO EN LA INTENSIDAD (P=,009) y la varianza de la suma GLCM (P=,004) fueron predictores independientes de BCR en el análisis multivariado.

Conclusión

La heterogeneidad tumoral en la PET con PSMA [68Ga]Ga previa al tratamiento se asocia con un alto riesgo de BCR en pacientes con CaP que se sometieron a terapias definitivas.

Palabras clave:
PET [68Ga]Ga-PSMA
Cáncer de próstata
Radiómica
Análisis de textura
Heterogeneidad tumoral

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