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Scintigraphic load of bone disease evaluated by DASciS software as a survival predictor in metastatic castration-resistant prostate cancer patients candidates to 223RaCl treatment

Viviana Frantellizzi
Viviana Frantellizzi
, 
Arianna Pani
Arianna Pani
, 
Maria Dea Ippoliti
Maria Dea Ippoliti
, 
Alessio Farcomeni
Alessio Farcomeni
, 
Irvin Aloise
Irvin Aloise
, 
Mirco Colosi
Mirco Colosi
, 
Claudia Polito
Claudia Polito
, 
Roberto Pani
Roberto Pani
 and 
Giuseppe De Vincentis
Giuseppe De Vincentis
   | Dec 19, 2019
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Article Category: Research Article
Published Online: Dec 19, 2019
Page range: 40 - 47
Received: Jun 18, 2019
Accepted: Oct 22, 2019
DOI: https://doi.org/10.2478/raon-2019-0058
© 2020 Viviana Frantellizzi, Arianna Pani, Maria Dea Ippoliti, Alessio Farcomeni, Irvin Aloise, Mirco Colosi, Claudia Polito, Roberto Pani, Giuseppe De Vincentis, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Patient of our cohort with bone metastases analyzed with DASciS software. Bone scan index (BSI) value = 5.26%.
Patient of our cohort with bone metastases analyzed with DASciS software. Bone scan index (BSI) value = 5.26%.

Figure 2

Kaplan-Meier curve for overall survival.
Kaplan-Meier curve for overall survival.

Figure 3

Bone scan index (BSI) over time.0 = baseline bone scan; 2–3 = bone scan after 2 and 3 cycles of Ra-223 therapy; 6 = bone scan after treatment’s end; 9 - 12 - 24 = follow-up scintigraphic image study respectively after 3 months, 6 months and 1.5 year from the end of the treatment
Bone scan index (BSI) over time.0 = baseline bone scan; 2–3 = bone scan after 2 and 3 cycles of Ra-223 therapy; 6 = bone scan after treatment’s end; 9 - 12 - 24 = follow-up scintigraphic image study respectively after 3 months, 6 months and 1.5 year from the end of the treatment

Figure 4

ROC curve of overall survival (OS) prediction for a score based on combining bone scan index (BSI) and 3-PS (AUC 91%).
ROC curve of overall survival (OS) prediction for a score based on combining bone scan index (BSI) and 3-PS (AUC 91%).

Figure 5

99mTc-HMDP Bone scan, example of evaluation of load of the disease. (A) Few but very extensive bone metastases. Bone scan index (BSI) value = 6.13%. (B) numerous but small bone metastases. BSI value = 3.4%.
99mTc-HMDP Bone scan, example of evaluation of load of the disease. (A) Few but very extensive bone metastases. Bone scan index (BSI) value = 6.13%. (B) numerous but small bone metastases. BSI value = 3.4%.

Univariate and multivariable analysis of overall survival (OS) in relation to baseline variables

Clinical covariatesUnivariate HR (95% models CI)p-valueMultivariable HR (95% CI) modelp-value
BSI1.80 (1.61–2.02)< 0.0011.79 (1.59–2.01)< 0.001
Age (years)1.02 (0.99–1.05)0.184
BMI0.94 (0.89–1.00)0.057
Gleason Score0.97 (0.91–1.04)0.414
ECOG Performance Status1.97 (1.48–2.64)< 0.0011.74 (1.29–2.36)< 0.001
N of previous systemic treatments1.35 (1.12–1.164)0.002
Baseline Hb0.73 (0.64–0.84)< 0.001
Baseline PLT / 1001.51 (1.19–1.92)< 0.001
Baseline PSA / 1001.06 (1.02–1.12)0.006
Baseline tALP /1001.11 (1.06–1.17)< 0.001

Expected survival for baseline bone scan index (BSI) intervals

% BSIPatients number (n = 127)Median survival (months)0.95 LowCL (months)0.95 UpCL (months)
0–3592819NA
3–53311912
> 535557

Baseline patients’ characteristics

Baseline variablePatients (n = 127)%
Age (years)
Mean (range)73.82 (59–90)
Heigth (m)
Mean (range)1.71 (1.58–1.95)
Weight (kg)
Mean (range)78.60 (59–120)
BMI
Mean (range)26.75 (19.57–39.18)
Gleason score
Mean (range)6.3 (5–10)
510.79
632.36
73829.92
83023.62
92822.04
1021.59
Unknown2519.68
ECOG Performance status
Mean (range)0.86 (0–3)
03930.7
16853.54
2–32015.75
Extent of skeletal disease
< 6 metastases1814.17
6–20 metastases4636.22
> 20 metastases6349.61
No. of previous systemic treatments after
castration resistance (Docetaxel, Cabazitaxel,
Abiraterone, Enzalutamide)
03225.19
14233.07
23225.19
≥ 32116.53
No. of therapy’s cycles administered
Mean (range)5.56 (2–6)
232.36
332.36
4107.87
51411.02
69776.38
No. of systemic treatments after Radium223
Docetaxel118.6
Cabazitaxel00
Abiraterone21.5
Enzalutamide64.7
Baseline Hb
Median (range)12.14 (7.5–15)
< 12 g/dl5442.51
≥ 12 g/dl7357.48
Baseline tALP*
Median (range)300 (34–1750)
< 226 U/l7962.2
≥ 226 U/l4887.8
Baseline PLT (103/mm3)
Median (range)249 (74–763)
Baseline PSA
< 20 ng/ml4233.07
≥ 20 ng/ml8566.92
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