{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T03:25:57Z","timestamp":1793676357176,"version":"4.5.1"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"13","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Bonn","id":[{"id":"https:\/\/ror.org\/01xnwqx93","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Nucl Med Mol Imaging"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      [\n                      <jats:sup>177<\/jats:sup>\n                      Lu]Lu-PSMA-617 is a standard-of-care therapy for metastatic castration-resistant prostate cancer (mCRPC). Given the heterogeneous clinical responses, accessible prognostic tools are needed. We recently demonstrated that the Bellmunt Risk Score (BRS)\u2014comprising ECOG performance status &gt;0, hemoglobin &lt;10\u00a0g\/dL, and the presence of liver metastases\u2014predicts overall survival (OS) in a primary mCRPC cohort. This study aims to externally validate the BRS in an independent cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively evaluated 243 mCRPC patients treated with [\n                      <jats:sup>177<\/jats:sup>\n                      Lu]Lu-PSMA-617 at an independent tertiary center. The BRS was calculated at baseline (range 0-3). Endpoints included OS analyzed via Kaplan-Meier estimators, multivariable Cox regression, Harrell\u2019s C-index, and time-dependent area under the curve (tAUC).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort was distributed into BRS 0 (17.6%), BRS 1 (52.7%), BRS 2 (26.1%), and BRS 3 (2.9%). Kaplan-Meier analysis revealed significant risk stratification, with an estimated median OS of 24.0, 15.8, 11.2, and 8.7 months for BRS 0, 1, 2, and 3, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). In univariable analysis, BRS significantly predicted survival. In multivariable Cox regression adjusted for the number of prior treatment lines, BRS 2 (HR 3.04,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and BRS 3 (HR 4.76,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002) remained independent predictors of shortened OS. The BRS demonstrated robust predictive accuracy, achieving a tAUC of 71.3% for 1-year OS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The BRS is a pragmatic, robust, and easily calculable prognostic tool for mCRPC patients undergoing [\n                      <jats:sup>177<\/jats:sup>\n                      Lu]Lu-PSMA-617 therapy, successfully validated in an independent external cohort.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-026-08169-7","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:39:52Z","timestamp":1788838792000},"page":"8514-8518","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["External validation of the bellmunt risk score for survival prediction in mCRPC patients undergoing [177Lu]Lu-PSMA-617 therapy"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0316-9621","authenticated-orcid":false,"given":"Thomas","family":"B\u00fcttner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Wenzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Mandel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milka","family":"Marinova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Essler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix K. H.","family":"Chun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Ritter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Groener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Krausewitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"8169_CR1","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.2967\/jnumed.123.266167","volume":"64","author":"ADDINENREFLIST Sartor","year":"2023","unstructured":"Sartor O, Ledet E, Huang M, Schwartz J, Lieberman A, Lewis B, et al. Prediction of resistance to 177Lu-PSMA therapy by assessment of baseline circulating tumor DNA biomarkers. J Nucl Med. 2023;64:1721\u20135. https:\/\/doi.org\/10.2967\/jnumed.123.266167.","journal-title":"J Nucl Med"},{"key":"8169_CR2","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1016\/S1470-2045(22)00605-2","volume":"23","author":"JP Buteau","year":"2022","unstructured":"Buteau JP, Martin AJ, Emmett L, Iravani A, Sandhu S, Joshua AM, et al. PSMA and FDG-PET as predictive and prognostic biomarkers in patients given [177Lu]Lu-PSMA-617 versus cabazitaxel for metastatic castration-resistant prostate cancer (TheraP): a biomarker analysis from a randomised, open-label, phase 2 trial. Lancet Oncol. 2022;23:1389\u201397. https:\/\/doi.org\/10.1016\/S1470-2045(22)00605-2.","journal-title":"Lancet Oncol"},{"key":"8169_CR3","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1016\/S1470-2045(21)00274-6","volume":"22","author":"A Gafita","year":"2021","unstructured":"Gafita A, Calais J, Grogan TR, Hadaschik B, Wang H, Weber M, et al. Nomograms to predict outcomes after 177Lu-PSMA therapy in men with metastatic castration-resistant prostate cancer: an international, multicentre, retrospective study. Lancet Oncol. 2021;22:1115\u201325. https:\/\/doi.org\/10.1016\/S1470-2045(21)00274-6.","journal-title":"Lancet Oncol"},{"key":"8169_CR4","doi-asserted-by":"publisher","first-page":"1850","DOI":"10.1200\/jco.2009.25.4599","volume":"28","author":"J Bellmunt","year":"2010","unstructured":"Bellmunt J, Choueiri TK, Fougeray R, Schutz FAB, Salhi Y, Winquist E, et al. Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. J Clin Oncol. 2010;28:1850\u20135. https:\/\/doi.org\/10.1200\/jco.2009.25.4599.","journal-title":"J Clin Oncol"},{"key":"8169_CR5","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-025-07492-9","author":"T B\u00fcttner","year":"2025","unstructured":"B\u00fcttner T, Marinova M, Gaertner FC, Kreppel B, Fritsche L, Immanuel C, et al. Bellmunt risk score enables survival prediction in men with metastatic castration resistant prostate cancer (mCRPC) undergoing PSMA-targeted radioligand therapy (LUMEN). Eur J Nucl Med Mol Imaging. 2025. https:\/\/doi.org\/10.1007\/s00259-025-07492-9.","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"8169_CR6","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/S1470-2045(24)00135-9","volume":"25","author":"L Emmett","year":"2024","unstructured":"Emmett L, Subramaniam S, Crumbaker M, Nguyen A, Joshua AM, Weickhardt A, et al. [177Lu]Lu-PSMA-617 plus enzalutamide in patients with metastatic castration-resistant prostate cancer (ENZA-p): an open-label, multicentre, randomised, phase 2 trial. Lancet Oncol. 2024;25:563\u201371. https:\/\/doi.org\/10.1016\/S1470-2045(24)00135-9.","journal-title":"Lancet Oncol"},{"key":"8169_CR7","doi-asserted-by":"publisher","first-page":"186","DOI":"10.3390\/diagnostics11020186","volume":"11","author":"S Moazemi","year":"2021","unstructured":"Moazemi S, Erle A, L\u00fctje S, Gaertner FC, Essler M, Bundschuh RA. Estimating the potential of radiomics features and radiomics signature from pretherapeutic PSMA-PET-CT scans and clinical data for prediction of overall survival when treated with 177Lu-PSMA. Diagnostics. 2021;11:186.","journal-title":"Diagnostics"}],"container-title":["European Journal of Nuclear Medicine and Molecular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-026-08169-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00259-026-08169-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-026-08169-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:29:31Z","timestamp":1793672971000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00259-026-08169-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":7,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["8169"],"URL":"https:\/\/doi.org\/10.1007\/s00259-026-08169-7","relation":{},"ISSN":["1619-7070","1619-7089"],"issn-type":[{"value":"1619-7070","type":"print"},{"value":"1619-7089","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]},"assertion":[{"value":"22 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This is an observational study. The responsible ethic committee at the Medical Faculty of University Frankfurt has confirmed that no informed consent is required (vote no. SUG-5-2024).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Thomas B\u00fcttner received speaker honorary and\/or expenses from Merck, Bayer, Astellas, MSD, Ipsen and Medac. Philipp Krausewitz received speaker honorary from Novartis and Johnson and Johnson. Daniel Groener received speaker honoraria from Sanofi, advisory board compensation Novartis. All other authors have no competing interests to declare that are relevant to the content of this article.","order":3,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}