Prior PSMA PET-CT Imaging and Hounsfield Unit Impact on Tumor Yield and Success of Molecular Analyses from Bone Biopsies in Metastatic Prostate Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Study Population
2.2. Clinical Parameters
2.3. Imaging and Procedural Characteristics
2.4. Uni- and Multivariable Analyses
2.5. Imaging Prediction Model
2.6. Druggable Pathogenic Mutations within a Bone-Predominant Cohort
3. Discussion
4. Materials and Methods
4.1. Study Population
4.2. Variable Definition
4.3. Sample Collection, DNA Extraction and Molecular Analysis
4.4. Outcomes
4.5. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Clinical Characteristics | No Tumor Cells Detected | Tumor Cells Present Median (q1–q3) or Percent | p-Value * | Insufficient Tumor Yield (<30%) | Sufficient Tumor Yield for Molecular Analysis (≥30%) Median (q1–q3) or Percent | p-Value * |
---|---|---|---|---|---|---|
Total | 76.4% (84/110) | 66.4% (73/110) 86.9% (73/84) | ||||
Age at the time of biopsy (years) | 65.0 (58.0–72.3) | 68.0 (62.0–73.0) | p = 0.281 | 65.0 (59.5–71.0) | 69.0 (62.0–74.0) | p = 0.137 |
Hormone status at the time of biopsy | p = 0.751 | p = 0.769 | ||||
HSPC † | 28.6% (N = 2) | 71.4% (N = 5) | 28.6% (N = 2) | 71.4% (N = 5) | ||
CRPC ‡ | 23.3% (N = 24) | 76.7% (N = 79) | 34.0% (N = 35) | 66.0% (N = 68) | ||
Prior radiotherapy on biopsied metastasis | p = 0.751 | p = 0.769 | ||||
Yes | 28.6% (N = 2) | 71.4% (N = 5) | 28.6% (N = 2) | 71.4% (N = 5) | ||
No | 23.3% (N = 24) | 76.7% (N = 79) | 34.0% (N = 35) | 66.0% (N = 68) | ||
Gleason score at primary diagnosis | p = 0.948 | p = 0.437 | ||||
<8 | 22/28 (78.6%) | 18/28 (64.3%) | ||||
≥8 | 57/72 (79.2%) | 52/72 (72.2%) | ||||
Laboratory values | ||||||
PSA (µg/L) | 38.0 (9.4–110.0) | 98.0 (20.5–245.0) | p = 0.029 | 54.0 (12.0–147.5) | 95.5 (21.3–315.0) | p = 0.126 |
Alkaline phosphatase (U/L) | 109.0 (78.5–140.3) | 117.0 (87.0–224.5) | p = 0.376 | 105.0 (78.0–138.0) | 128.0 (87.5–232.8) | p = 0.100 |
Albumin (g/L) | 34.0 (33.0–36.0) | 36.0 (34.0–38.3) | p = 0.040 | 34.0 (33.0–39.0) | 36.0 (34.0–38.0) | p = 0.567 |
LDH (U/L) | 221.0 (197.8–264.3) | 220.0 (180.0–249.0) | p = 0.636 | 220.5 (201.5–264.8) | 220.0 (179.0–247.0) | p = 0.768 |
Hemoglobin (mmol/L0) | 7.9 (7.4–8.3) | 7.7 (6.8–8.3) | p = 0.376 | 7.9 (7.1–8.4) | 7.7 (6.9–8.3) | p = 0.795 |
Leukocytes (×109/L) | 6.6 (5.5–7.9) | 6.1 (4.8–7.9) | p = 0.340 | 6.0 (5.2–7.4) | 6.1 (4.8–8.2) | p = 0.910 |
Thrombocytes (×109/L) | 236.0 (202.5–287.5) | 234.0 (171.3–284.0) | p = 0.550 | 228.5 (180.5–286.3) | 238.0 (184.0–286.0) | p = 0.448 |
Imaging and Procedural Characteristics | Tumor Cells Present (N = 84) | p-Value * | Sufficient Tumor Yield for Molecular Analysis (≥30%) | p-Value * | ||
---|---|---|---|---|---|---|
(N = 73) | ||||||
Median (q1–q3) or Number (Percent) | Median (q1–q3) or Number (Percent) | |||||
Imaging characteristics | ||||||
Imaging type | p = 0.037 | p = 0.292 | ||||
CT | 23/36 (63.9%) | 21/36 (58.3%) | ||||
MRI | 8/12 (66.7%) | 7/12 (58.3%) | ||||
PSMA PET-CT ¥ | 53/62 (85.5%) | 45/62 (72.6%) | ||||
(68Ga-PSMA N = 52; F18-PSMA N = 10) | ||||||
Biopsy location | p = 0.027 | p = 0.012 | ||||
Pelvis | 57/79 (72.2%) | 47/79 (59.5%) | ||||
Spine | 23/24 (95.8%) | 22/24 (91.7%) | ||||
Other (3 rib,3 extremity, 1 scapula) | 4/7 (57.1%) | 4/7 (57.1%) | ||||
Procedural characteristics | ||||||
Radiologist/fellow Radiologist | 56/73 (76.7%) | p = 0.942 | 51/73 (69.9%) | p = 0.268 | ||
Fellow | 17/23 (73.9%) | 12/23 (52.2%) | ||||
Internist | 11/14 (78.6%) | 10/14 (71.4%) | ||||
Quantitative attenuation | No tumor cells | Tumor cells present | p-Value | Insufficient tumor yield | Sufficient tumor yield | p-Value |
HU † | 597.6 (327.4–824.9) | 447.4 (206.4–579.1) | p = 0.025 | 581.9 (333.0–807.2) | 445.8 (182.7–553.1) | p = 0.010 |
Dev ‡ | 174.4 (102.3–223.8) | 119.3 (72.0–154.7) | p = 0.023 | 174.6 (104.4–220.7) | 111.3 (71.6–147.1) | p = 0.006 |
ROI ± | 39.6 (33.6–45.0) | 34.0 (26.5–41.6) | p = 0.108 | 38.6 (32.3–44.7) | 34.0 (26.0–41.8) | p = 0.193 |
Variable | Successful Histology OR † (95% CI) | p-Value | Successful Genetic Analysis OR † (95% CI) | p-Value |
---|---|---|---|---|
Imaging Type | ||||
CT | A | A | ||
MRI | 1.13 (0.29–4.49) | p = 0.862 | 1.00 (0.27–3.76) | p = 1.000 |
PSMA PET-CT | 3.33 (1.25–8.88) | p = 0.016 | 1.89 (0.795–4.496) | p = 0.150 |
Biopsy location | ||||
Pelvis | B | B | ||
Spine | 8.88 (1.13–69.77) | p = 0.038 | 7.49 (1.65–34.09) | p = 0.009 |
Other | 0.52 (0.11–2.49) | p = 0.409 | 0.91 (0.19–4.33) | p = 0.903 |
HU | 0.998 (0.996–1.000) | p = 0.034 | 0.998 (0.996–1.000) | p = 0.016 |
Dev | 0.990 (0.983–0.998) | p = 0.017 | 0.989 (0.981–0.997) | p = 0.008 |
ROI | 0.986 (0.953–1.020) | p = 0.420 | 0.992 (0.960–1.025) | p = 0.639 |
ROI log 10 | 0.110 (0.003–3.797) | p = 0.222 | 0.186 (0.006–5.365) | p = 0.327 |
Groups Categorized by HU and Dev | Tumor Cells Present | Odds Ratio | Successful Molecular Analysis (≥30%) | Odds Ratio |
---|---|---|---|---|
Group 1 HU < 713.50 and Dev < 178.90 | 36/44 (81.8%) | A | 34/44 (77.3%) | A |
Group 2 HU ≥ 713.50 or Dev ≥ 178.90 | 10/18 (55.6%) | 0.278 (p = 0.037) | 8/18 (44.4%) | 0.235 (p = 0.235) |
Group 3 HU ≥ 713.50 and Dev ≥ 178.90 | 4/9 (44.4%) | 0.178 (p = 0.026) | 3/9 (33.3%) | 0.147 (p = 0.016) |
Reference | N | Imaging | Diagnostic Yield | Sufficiency for Molecular Analysis | Type of Molecular Analysis |
---|---|---|---|---|---|
[15] | 80 | CT-guided | 69% | 64% | RNA NGS ‡ |
[16] | 115 | Unguided | 62.% | Not performed | |
[9] | 39 | CT-guided | 77% | Not performed | |
[17] | 43 | MRI | 72.1% | Not performed | |
[18] | 184 | Unguided | 25.5% | Not performed | |
[19] | 70 | CT-guided | 85.7% | WES † 81.7% ➔ RNA-seq 33.3% | DNA WES † |
[20] | 54 | CT-guided | 67% | 39% | RNA microarray analysis |
[26] | 10 | CBCT- Guided * | 90% | 80% | Single molecular inversion probe and WES † |
Current study | 110 | 76.4% | 66.4% of total; 86.8% of biopsies with histological documentation of tumor cells | WES † and/or targeted NGS ‡ (possible when ≥30% tumor cells are available) |
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Smits, M.; Ekici, K.; Pamidimarri Naga, S.; van Oort, I.M.; Sedelaar, M.J.P.; Schalken, J.A.; Nagarajah, J.; Scheenen, T.W.J.; Gerritsen, W.R.; Fütterer, J.J.; et al. Prior PSMA PET-CT Imaging and Hounsfield Unit Impact on Tumor Yield and Success of Molecular Analyses from Bone Biopsies in Metastatic Prostate Cancer. Cancers 2020, 12, 3756. https://doi.org/10.3390/cancers12123756
Smits M, Ekici K, Pamidimarri Naga S, van Oort IM, Sedelaar MJP, Schalken JA, Nagarajah J, Scheenen TWJ, Gerritsen WR, Fütterer JJ, et al. Prior PSMA PET-CT Imaging and Hounsfield Unit Impact on Tumor Yield and Success of Molecular Analyses from Bone Biopsies in Metastatic Prostate Cancer. Cancers. 2020; 12(12):3756. https://doi.org/10.3390/cancers12123756
Chicago/Turabian StyleSmits, Minke, Kamer Ekici, Samhita Pamidimarri Naga, Inge M. van Oort, Michiel J. P. Sedelaar, Jack A. Schalken, James Nagarajah, Tom W. J. Scheenen, Winald R. Gerritsen, Jurgen J. Fütterer, and et al. 2020. "Prior PSMA PET-CT Imaging and Hounsfield Unit Impact on Tumor Yield and Success of Molecular Analyses from Bone Biopsies in Metastatic Prostate Cancer" Cancers 12, no. 12: 3756. https://doi.org/10.3390/cancers12123756