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Abstract

Abstract Title

Performance of 68Ga-PSMA-11 PET/CT for diagnosing tumor thrombus and predicting response to pembrolizumab and axitinib in patients with renal cell carcinoma: a pilot, retrospective study

Presentation Type

Podium Abstract

Manuscript Type

Clinical Research

Abstract Category *

Oncology: Kidney (non-UTUC)

Author's Information

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Co-author 1

Shao-Hao Chen shaohao.chen@fjmu.edu.cn The First Affiliated Hospital of Fujian Medical University Fuzhou China *

Co-author 2

Bo-Han Lin drlin.urology@fjmu.edu.cn The First Affiliated Hospital of Fujian Medical University Fuzhou China -

Co-author 3

Shao-Ming Chen shaoming81@163.com The First Affiliated Hospital of Fujian Medical University Fuzhou China -

Co-author 4

Ning Xu drxun@fjmu.edu.cn The First Affiliated Hospital of Fujian Medical University Fuzhou China -

Co-author 5

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Co-author 16

Co-author 17

Co-author 18

Co-author 19

Co-author 20

Abstract Content

Introduction

To investigate the performance of 68Ga-prostate-specific membrane antigen-11 positron emission tomography/computed tomography (68Ga-PSMA-11 PET/CT) for diagnosing tumor thrombus (TT) and predicting response to pembrolizumab and axitinib in clear cell renal cell carcinoma (ccRCC) with TT.

Materials and Methods

162 renal cell carcinoma patients who underwent 68Ga-PSMA-11 PET/CT were included; among them, 31 ccRCC patients (22 male; mean age 55.90±13.36 years) with TT received a median of five treatment cycles of pembrolizumab and axitinib. The response to neoadjuvant therapy was evaluated according to the RECIST 1.1 criteria, and the diagnostic performance was assessed through the area under the curve (AUC).

Results

The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and AUC of 68Ga-PSMA-11 PET/CT in diagnosing TT were 0.96, 0.97, 0.97, 0.94, 0.97, and 0.97 (95%CI 0.93-0.99) respectively, and 0.91, 0.89, 0.90, 0.94, 0.85, and 0.90 (95%CI 0.79-0.97) in distinguishing early vs advanced TT. The maximum standardized uptake values (SUVmax) for TT was significantly higher than that of the primary tumor lesion (17.65±7.27 vs. 14.04±5.98, P=0.037) and varied significantly among different Mayo levels (P=0.001). The TT length and diameter showed a positive correlation with SUVmax (both P<0.01). Elevated neutrophil counts, neutrophil-to-lymphocyte ratio, and interleukin-6 (IL-6) levels, along with decreased SUVmax, were associated with poor therapeutic efficacy (all P<0.05). Among them, SUVmax for TT was more effective than others with an AUC of 0.75 (95%CI 0.56-0.89).

Conclusions

68Ga-PSMA-11 PET/CT is a promising tool for diagnosing TT and predicting response to pembrolizumab and axitinib in ccRCC patients.

Keywords

Renal tumor; Thrombus; PSMA PET/CT; Hematological indicators; Neoadjuvant therapy

Figure 1

https://storage.unitedwebnetwork.com/files/1237/50a886067c2c2beb4d6c16784fb576d7.jpg

Figure 1 Caption

Figure 1 Trial design and conduct. A Flow diagram of patient recruitment and study procedures. B Study schema. 68Ga-PSMA-11 PET/CT, 68Ga-prostate-specific membrane antigen-11 positron emission tomography / computed tomography; RCC, renal cell carcino

Figure 2

https://storage.unitedwebnetwork.com/files/1237/b60501bc466d977554d06c4f6f61984f.jpg

Figure 2 Caption

Figure 2 68Ga-PSMA-11 PET/CT imaging characteristics of ccRCC with TT and representative images of matched radio-pathological cases. Images show variations in radiotracer uptake in TT at various Mayo levels compared with the primary lesion of ccRCC.

Figure 3

https://storage.unitedwebnetwork.com/files/1237/a5e4990e6fec2582e747bad74b74c9f4.jpg

Figure 3 Caption

Figure 3 Sankey diagram showing number of patients with tumor thrombus Mayo level 0–IV and their changes before and after neoadjuvant therapy.

Figure 4

https://storage.unitedwebnetwork.com/files/1237/968827e397952a62186192a21d7a27d8.jpg

Figure 4 Caption

Figure 4 Bar charts depicting the correlation between clinical factors and the effectiveness of neoadjuvant therapy. BMI, body mass index; CT, computed tomography; CRP, C-reactive protein; PLT, platelet count; PLR, platelet-to-lymphocyte ratio; LMR,

Figure 5

https://storage.unitedwebnetwork.com/files/1237/d4651b13c1b3f8bcab4cd171b1711080.jpg

Figure 5 Caption

Figure 5 ROC curves comparing the effectiveness of 68Ga-PSMA-11 PET/CT SUVmax and hematological indicators in predicting response to pembrolizumab and axitinib in clear cell renal cell carcinoma with tumor thrombus. ANC, absolute neutrophil count; NL

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